Literature Reviews Conducted For Two Different Types Of Studies

Literature Reviews Conducted For Two Different Types Of Studies

Literature Reviews Conducted For Two Different Types Of Studies

Identify and discuss the research questions, sampling and sampling sizes, research designs (qualitative vs. quantitative), hypothesis, data collection methods, and research findings.

Discuss the credibility of the sources and the research/researcher findings.

400-word minimum/550-word maximum without the references.

Minimum of 3 references (the course textbook must be one of the references) in APA format, must have been published within last 3-5 years

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several disciplines. Both education and nursing in general have been attempting to define, teach, and measure this concept for decades. Nurse educators realize that critical thinking is the cornerstone of the objectives and goals for nursing students. The purpose of this article is to review and analyze quantitative research findings relevant to the measurement of critical thinking abilities and skills in undergraduate nursing students and the usefulness of critical thinking as a predictor of National Council Licen- sure Examination-Registered Nurse (NCLEX-RN) perfor- mance. The specific issues that this integrative review ex- amined include assessment and analysis of the theoretical and operational definitions of critical thinking, theoretical frameworks used to guide the studies, instruments used to evaluate critical thinking skills and abilities, and the role of critical thinking as a predictor of NCLEX-RN out- comes. A list of key assumptions related to critical think- ing was formulated. The limitations and gaps in the litera- ture were identified, as well as the types of future research needed in this arena.

Higher education has attempted to change the way in which the nursing curriculum is structured (Ad-ams, 1999). It is no longer acceptable to teach only knowledge-based facts and skills; instead, the emphasis has shifted toward guiding students to become lifelong, in- dependent critical thinkers (Lee, 2007). Starting in the late 1980s, colleges of nursing moved from evaluation of the cur- riculum to assessment of student outcomes (Riddell, 2007). Nursing faculty must continue this shift from an emphasis on teaching nursing content to one focusing on the applica- tion of nursing knowledge (Adams, 1999; Del Bueno, 2005). The application of nursing knowledge within the nurs- ing process is enhanced through utilization of the process of critical thinking (National League for Nursing [NLN], 2007). Nurse educators remain accountable for creating and implementing curricula that produce graduate nurses who are able to use critical thinking skills to formulate ap- propriate clinical and nursing judgments (Henriques, 2002; Hoffman, 2006; NLN, 2007; Youssef & Goodrich, 1996). Literature Reviews Conducted For Two Different Types Of Studies

The National Council of State Boards of Nursing (NCSBN) is an organization through which boards of nursing act collaboratively on matters of public health, safety, and welfare (NCSBN, 2007). This organization is also responsible for the development of the licensing ex- aminations in nursing. Because the NCSBN considers critical thinking to be an important component in nursing education and the National Council Licensure Examina- tion-Registered Nurse (NCLEX-RN) measures graduates’ competency for entry into practice, it is presumed that critical thinking is one element of nursing that is tested by the NCLEX-RN (Giddens & Gloeckner, 2005). According to the NCSBN, the majority of items on the NCLEX-RN are written at the application and analysis level of Bloom’s taxonomy. Successful performance on the NCLEX-RN re- quires the use of critical thinking to correctly answer ques- tions at this cognitive level (Wacks, 2005; Wendt, 2003; Wendt & Brown, 2000).

Received: October 30, 2008 Accepted: October 27, 2009 Posted: March 31, 2010 Ms. Romeo is Clinical Instructor, Gwynedd-Mercy College, School

of Nursing, Gwynedd Valley, Pennsylvania. The author has no financial or proprietary interest in the material

presented herein. Address correspondence to Elizabeth M. Romeo, MS, CRNP,

FNP, Clinical Instructor, 405 Stonebridge Road, Perkasie, PA 18944; e-mail: romeo.e@gmc.edu.

doi:10.3928/01484834-20100331-05

378 Copyright © SLACK Incorporated

ROMEO

METHOD FOR INTEGRATIVE REVIEW

The process that was used for this integrative review was the template proposed by Whittemore and Knafl (2005). Their method for conducting an integrative review includes the following five stages: a problem identification stage, with the definition of relevant terms; a literature search stage, to identify all significant literature on the topic; a data evaluation stage, with the recommendation to include similar designs; a data analysis stage that en- compasses data reduction, data display, data comparison, conclusion drawing, and verification; and a final presenta- tion stage that is generally reported in a table or diagram- matic form (Whittemore & Knafl, 2005).

Problem Identification Stage and Identification of Relevant Terms

Critical thinking is an attribute that enhances one’s skill in problem solving and decision making. The purpose of this article is to review and analyze recent quantitative research findings relevant to measuring critical thinking abilities and skills in undergraduate nursing students and critical thinking’s role as a predictor of NCLEX-RN performance. The specific issues that this integrative re- view will examine include assessment and analysis of the theoretical and operational definitions of critical thinking, theoretical frameworks used to guide the studies, tools to evaluate critical thinking skills and abilities, and the role of critical thinking as a predictor of NCLEX-RN outcomes. A list of key assumptions related to critical thinking will be formulated. The limitations and gaps in the literature will be identified, as well as the types of future research needed in this area. Literature Reviews Conducted For Two Different Types Of Studies

Theoretical Definitions of Critical Thinking Nursing has evolved from a simplistic occupation to a

complex and highly technical profession; therefore, nurses have changed from being task-oriented team members to becoming autonomous health care providers (Allen, Ru- benfeld, & Scheffer, 2004). Due to the increasing complex- ity of the clinical setting, the need to develop and nur- ture critical thinking skills is paramount (Frye, Alfred, & Campbell, 1999). A concise definition of the concept of critical thinking is one that various disciplines continue to struggle with today (Akerson, 2001; Allen et al., 2004; Frye et al., 1999; Kataoka-Yahiro & Saylor, 1994).

The studies reviewed in this integrative review in- cluded a variety of definitions of critical thinking. The definition offered by Paul (1993) is that it is a method of examining one’s thinking with the goal of improving the thought process to make it clearer and more accu- rate (Frye et al., 1999). In the study conducted by Wacks (2005), the definition of critical thinking used was from the work of Watson and Glaser (1980), who defined it as a combination of one’s attitudes, level of knowledge, and skills. Akerson (2001) offered yet another definition of critical thinking that is specific to nursing and is based on the work of Kataoka-Yahiro and Saylor (1994). Accord-

ing to Akerson, critical thinking is a process involving critical, reflective, and reasonable thinking about prob- lems specific to nursing practice that do not have a single answer and is centered on deciding what to do or believe. It also has been defined as a cognitive procedure that drives problem solving and decision making (Henriques, 2002). Frost (2000) offered another definition of critical thinking that is specific to nursing: critical thinking is a process involving critical, reflective practice with a basis in sound reasoning of intelligent minds that are commit- ted to safe and effective patient care. The process of criti- cal thinking is best measured from a holistic perspective encompassing both abstract thinking and the practice skills that are unique to the nursing environment (Hoff- man, 2006).

One of the first intensive research studies done to de- velop a widely accepted theoretical definition for critical thinking was undertaken in 1990 by means of the Delphi method. A panel of 46 experts from the United States and Canada from different scholarly disciplines participated in this 2-year project in an effort to globally define critical thinking. Peter Facione, PhD, is internationally known for his work on the definition and measurement of critical thinking. His research on teaching and assessing critical thinking has been ongoing for the past 40 years. Dr. Fa- cione was a prominent member of The Delphi Report in 1990, which defined critical thinking as a decisive, self- regulated judgment that promotes a forum in which to ad- dress clinical and professional nursing issues in an effec- tive method. According to Facione (1990), “critical thinking is essential as a tool of inquiry” (p. 3). The ideal critical thinker continually draws on past experiences and one’s knowledge base to honestly and openly assess and resolve complex issues in an orderly fashion (Facione, 1990; Mor- ris, 1999; Morris, 1998).

Stewart and Dempsey (2005) defined critical thinking from the specific standpoint of the American Philosophi- cal Association (1990), which describes critical thinking dispositions. These dispositions include attributes such as “habits of the mind, intellectual virtues, a character- ological profile, and a set of attitudes toward thinking pro- cesses” (Stewart & Dempsey, 2005, p. 81). Critical think- ing has also been defined as a vibrant, purposeful, logical process that results in articulate decisions and judgments. The process of critical thinking in this definition encom- passes interpretation, analysis, evaluation, inference, explanation, and self-regulation (Whitehead, 2006). The final study reviewed did not provide a definition of critical thinking (Youssef & Goodrich, 1996). Literature Reviews Conducted For Two Different Types Of Studies

One definition of critical thinking that is important to nursing and was not found in any of the reviewed studies is the definition based on the work of Scheffer and Ruben- feld (2000). They also used the Delphi technique with five rounds of input to achieve a definition of critical thinking specifically for the discipline of nursing. The participants in that study consisted of an international panel of expert nurses representing 9 countries and 23 states in the Unit- ed States who worked from 1995 to 1998 to develop the fol-

Journal of Nursing Education • Vol. 49, No. 7, 2010 379

QUANTITATIVE RESEARCH ON CRITICAL THINKING

lowing consensus definition of critical thinking in nursing (Scheffer & Rubenfeld, 2000):

Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Criti- cal thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, in- quisitiveness, intellectual integrity, intuition, open-mind- edness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking logical rea- soning, predicting and transforming knowledge. (p. 357)

LITERATURE SEARCH

Data Collection The literature review was conducted via hand, Inter-

net, and database searches from January to April 2008. Computer searches used the Cumulative Index for Nursing and Allied Health Literature, ProQuest Nurs- ing Journals, and PubMed. Search words that were used in various combinations in- cluded “critical thinking,” “nursing, students,” “research instruments,” “quantitative research,” “pretest-posttest,” and “NCLEX-RN results.” The Cumulative Index for Nursing and Allied Health Literature, ProQuest, and PubMed data- bases produced 20, 10, and 23 articles, respectively, which were selected based on specific inclusion and exclusion cri- teria. The inclusion criteria were studies that were quanti- tative in design, research articles published in professional journals, and dissertations written in English, and they in- volved undergraduate nursing students, described the use of a critical thinking assessment tool, and were published between 1988 and 2008.

Undergraduate nursing students were the population selected because the majority of studies pertaining to critical thinking are based on this group. The inclusion of studies that contain a quantitative critical thinking tool was necessary to measure the independent variable. The rationale for the dates of the search was to coincide with the implementation of the current format for the NCLEX- RN as a pass/fail examination. Exclusion criteria included qualitative research, graduate nursing students compris- ing the population, editorials and articles published prior to 1988, studies involving a specific intervention to en- hance critical thinking with no correlation to NCLEX-RN outcomes, abstracts without full text, case studies, letters, or secondary sources. Literature Reviews Conducted For Two Different Types Of Studies

There were 8 articles that met the criteria for inclu- sion in this project. An ancestry search and citation-in- dex search were conducted on the 8 articles, which were initially found in the 3 different Internet databases. An

additional 4 articles that met the criteria were found, for a total of 12 relevant articles for this integrative re- view.

Data Analysis and Interpretation This integrative review revealed four different meth-

ods that have been used to study the critical thinking abilities of nursing students in comparison to NCLEX-RN outcomes. The first method used was the measurement of critical thinking abilities at the beginning and at the end of the nursing curriculum, which was used as a predictor of NCLEX-RN success. A second method measured criti- cal thinking abilities once at either the beginning or the end of the nursing program and examined students’ criti- cal thinking abilities as a predictor of NCLEX-RN suc- cess. The third method used in one study measured criti- cal thinking by means of repeated measurements taken

five times over the course of the students’ education. The final method that was used in three studies examined the differences between two distinct types of students in regard to their critical think- ing abilities and NCLEX-RN scores. The analysis and in- terpretation of the articles are categorized by these methods. A summary table of the studies is located in the Table.

Key Assumptions from Integrative Review Several assumptions of critical thinking that were ei-

ther implied or explicitly stated became apparent in the course of this review (Hall, 1996; Stewart & Dempsey, 2005; Wacks, 2005):

Critical thinking is widely accepted as a skill that is necessary in the practice of professional nursing.

Critical thinking skills can be taught, learned, and measured.

Students in the studies make an honest effort to per- form well on the tests.

Data Comparison The state of the science in regard to studies that have

been conducted on critical thinking in nursing education and practice is expansive, as found during the process of this integrative review. However, few studies have exam- ined critical thinking as a predictor of NCLEX-RN perfor- mance. Several limitations in these studies were identified in the process of this review. Some of the major limitations identified were related to the lack of a theoretical or con- ceptual framework, sampling issues, the definition of criti- cal thinking, and measurement tools. The lack of quanti- tative studies available that use critical thinking as an independent variable and NCLEX-RN as the dependent variable substantiate the need for further research.

The lack of quantitative studies Literature Reviews Conducted For Two Different Types Of Studies

available that use critical thinking as an

independent variable and NCLEX-RN as

the dependent variable substantiate the

need for further research.

380 Copyright © SLACK Incorporated

ROMEO

Theoretical Frameworks Most quantitative research has the common underly-

ing goal of testing the relationships that are suggested by theories. Of the 12 studies that were reviewed, only 5 in- cluded a theoretical framework that guided the research (Akerson, 2001; Hoffman, 2006; Morris, 1999; Wacks, 2005; Whitehead, 2006). Because there is currently not one accepted theory of critical thinking, each of the 5 stud- ies used a different theory, which further demonstrated the infancy of the state of the science in studying critical thinking. The remaining research studies did not include any framework or theory as a guide for the study.

Theoretical Definition of Critical Thinking Because there is currently a lack of an accepted frame-

work for critical thinking, there is not a widely acknowl- edged and accepted theoretical definition. As previously noted, there is a plethora of both theoretical and opera- tional definitions for critical thinking. As a discipline, nursing is in need of agreement on and acceptance of one of the current, concise theoretical definitions of critical thinking for use in education and clinical practice (Adams, 1999; Frye et al., 1999; Hall, 1996; Stewart & Dempsey, 2005). Interestingly, neither of the current nursing- specific definitions of critical thinking—the one developed by the NLN for clinical nursing practice or the definition from the work of Scheffer and Rubenfeld (2000)—were used as the theoretical definition for critical thinking in any of the studies that were analyzed. Because the theo- retical definition of critical thinking is directly related to a critical thinking theory, the exploration of these two fac- tors needs be conducted simultaneously. The operational definitions of critical thinking will remain tool specific, with a need to continue studying the reliability and valid- ity of the measures of critical thinking.

Critical Thinking Measurement Tools The California Critical Thinking Skills Test. The

majority of the valid and reliable tools available to mea- sure critical thinking skills and abilities are not specific for use with nursing students. The measurement tool that was used most frequently was the California Critical Thinking Skills Test, which yielded mixed findings in the reviewed studies. The California Critical Thinking Skills Test is a 34-item multiple choice test that measures over- all critical thinking skills, in addition to 5 subscales that specifically assess analysis, evaluation, inference, and deductive and inductive reasoning (Brunt, 2005; Phillips, Chestnut, & Rospond, 2004). This is a timed test of 45 minutes, with a maximum score of 34 on the skills test (Brunt, 2005). Literature Reviews Conducted For Two Different Types Of Studies

 

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