Theoretical model of critical thinking in diagnostic processes in nursing

INTRODUCTION
Contents:
  1. Nursing, Bachelor about Research (B.S.), accelerated program
  2. The Importance of Critical Thinking Skills in Nursing
  3. 2 The Diagnostic Process | Improving Diagnosis in Health Care | The National Academies Press

The purpose of the research was to identify whether students could develop their critical thinking abilities after participating in these sessions as a teaching strategy. All 60 senior nursing students in Shaheed Beheshti Faculty of Nursing and Midwifery were selected and randomly divided into two equal control and experimental groups.

Nursing, Bachelor about Research (B.S.), accelerated program

These students passed their clinical training in health clinics affiliated to the university. The subjects voluntarily participating in the study were between 22 and 24, with similar educational record. They were matched according to age, sex, term of study and passed units. No student was excluded during the research. A questionnaire consisted of 12 questions and four clinical report forms to evaluate critical thinking skills were used for data collection.

The forms were designed according to nursing process steps Assessment, Diagnosis, Planning, and Evaluation with a space provided to write clinical reasoning in each stage. Validity of the questionnaire was determined by content validity and internal reliability was measured by internal consistency internal consistency: To identify reliability in rating, an inter-rater reliability was measured interrater reliability: 0.

The Importance of Critical Thinking Skills in Nursing

It was supposed that by applying nursing process to analyze data, find different problems of clients, and provide the reasons behind any comment, suggestion or solution, students could reach to high levels of cognition according to Bloom's taxonomy and such activities could improve critical thinking abilities. According to Morrison and Walsh Free , questions that require calculation or ask what is the best, most important, first, highest priority , and so forth, require a high level of discrimination to answer, and therefore promote critical thinking.

Such multilogical test items require the ability to relate and apply concepts to clinically-oriented situations and measure the students' ability to think critically within the discipline of nursing. Each group was further divided into four subgroups with seven or eight members.


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For the experimental subgroups two seven-member and two eight-member subgroups , eight to ten group-dynamic sessions, each lasted 1 to 1. The topics of the sessions were chosen from the concepts of family health to be discussed over one or two sessions. A leader in the group involved the members by asking their views about the selected topic and discussing about it from different perspectives.

The roles of community health nurse were discussed by each member to identify different aspects and probable problems, and appropriate ways or solutions were identified by providing reasons or arguments. At the end of each session, the topics of the next session as well as the leader of the group were announced by researchers. For each subgroup, sessions were held over 25 days and the whole intervention was completed during 5 months. Having clinical conferences and home visits, the control group passed their routine training.

The researchers visited students in the experimental group once a week in the clinics to deliver new forms and solve any possible trouble regarding the completion of forms. These students completed their clinical forms in accordance with the sessions and assessment of families during their visits one form in each week. On the other hand, students in the control group delivered their forms at the end of their course and assessment of families. They were guided to contact with the researchers as necessary to solve any problem or clarify any misunderstanding in the completion of forms.

The groups did not have any communication or relation with each other. About two weeks after the last session, all of the forms from both groups were collected and scored in single-blind format by using a devised scale. To score critical thinking abilities in the students of both groups, mean scores of responses to questions in each area including seeking information 1 point , diagnosis 2 points , clinical reasoning 9 points , clinical judgment 6 points , prediction 1 point , and creativity 1 point were calculated as the score of each ability. The range of scores was between 0 and Findings revealed that the majority of students in both groups were female and unmarried, with no occupation or experience at group work.

They mostly lived with their parents. Table 1 shows the mean scores of clinical report forms in both groups. In table 2, the mean scores of each critical thinking skill in both groups are presented. Table 3 provides the total scores of critical thinking abilities in both groups. Additionally, diagram 1 shows the difference between critical thinking abilities in both groups. Figure 1 Table 1: Mean scores of clinical report forms in the control and experimental groups. Figure 2 Table 2: Mean scores of critical thinking subscales in the control and experimental groups.

Figure 3 Table 3: Mean total scores of critical thinking in the control and experimental groups. Figure 4 Diagram 1: Mean scores of critical thinking subscales in both groups. Since demographic variables have been shown to be effective on critical thinking, the groups were matched in our study to avoid unwanted effects of intervening variables. Bowles found a positive relationship between critical thinking and clinical-judgment abilities in baccalaureate nursing students. According to Loving , the concept of critical thinking encompasses problem-solving, decision-making, clinical judgment, and creativity.

All of these abilities were assessed and measured by the clinical report forms devised in this study and the researchers believe that they have been able to appraise critical thinking skills. Thus, the hypothesis of the study was supported with respect to the significant difference between the total scores of critical thinking abilities of the two groups. Magnussen, Ishida, and Itano have showed that inquiry-based learning as a teaching methodology can develop critical thinking abilities.

In addition, it has been indicated that these abilities are not developed during routine educational programs of nursing, which reveals the ineffectiveness of traditional teaching models in this regard.

This is similar to our study in terms of assessing the impact of a cooperative learning method group dynamics on improving these abilities and changing the routine lecture-based educational programs. In fact, it appears that the effect of cooperation on the process of learning is so evident that such significant improvements can be observed in our study. Hence, this study presents a newly devised tool to assess critical thinking development in nursing as a specific discipline.

The nursing process embedded in the questions of the tool can be considered as a framework for critical thinking with such skills as analyzing, applying standards, discriminating, logical reasoning, predicting, and transforming knowledge. The open-ended questions based on the concepts of family in community health nursing provided a challenge according to the students to use these skills and to improve their critical thinking abilities.

This may be due to allocation of low score 1 point to assessment, which has statistically brought about no significant difference. In fact, further studies in other courses of nursing with greater number of samples and specifically designed tools are needed to have more definite and conclusive findings regarding critical thinking.

It is evident that new learning methods should be applied to nursing education to generate nurses with powerful judgment and, therefore, skillful practice. Thinking and practicing are not dividable and the latter follows the former. Thinking allows nurses to find out what types of care should be provided and what activities should be performed with respect to clients' condition. It can be concluded that the more educators provide scenes for better and deeper thinking, the better learners can understand and analyze phenomena in the surrounding world to be better thinkers for better life.

We would like to thank the administrative staff of Tarbiat Modarres University and Shaheed Beheshti Faculty of Nursing and Midwifery for their assistance and cooperation. We would also like to express our gratitude to Ms. Kamelia Rouhani, community health nursing instructor in Shaheed Beheshti Faculty of Nursing and Midwifery, for her sincere cooperation during the implementation of the study. Finally, we are indebted to all students who participated in the study with full cooperation. Keywords community health nursing, critical thinking skills, group dynamics, nursing students.

Abstract The aim of this quasi-experimental study was to determine the effects of holding group-dynamic sessions in clinical training on critical thinking skills of baccalaureate nursing students. Introduction The importance of critical thinking in nursing is so evident that educational programs are evaluated according to the development of skills related to this sort of thinking.

Purpose This quasi-experimental study was conducted to determine the effects of group-dynamic sessions on critical thinking skills of baccalaureate nursing students. Methods All 60 senior nursing students in Shaheed Beheshti Faculty of Nursing and Midwifery were selected and randomly divided into two equal control and experimental groups.

Results Findings revealed that the majority of students in both groups were female and unmarried, with no occupation or experience at group work. Acknowledgements We would like to thank the administrative staff of Tarbiat Modarres University and Shaheed Beheshti Faculty of Nursing and Midwifery for their assistance and cooperation. Correspondence to Dr. Manoochehri, Dr. HoumanManoochehri gmail. References r Abegglen, J. Critical thinking in nursing: classroom tactics that work.

Journal of Nursing Education, 36 10 , Adams, B. Nursing education for critical thinking: An integrative review. Journal of Nursing Education, 38 3 , Adams, M. A longitudinal evaluation of baccalaureate nursing students' critical thinking abilities. Critical thinking in clinical learning: a holistic perspective. Holistic Nursing Practice, 10 3 , Alfaro-LeFevre, R.

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2 The Diagnostic Process | Improving Diagnosis in Health Care | The National Academies Press

Critical thinking in nursing: A practical approach. Philadelphia: W. Bandman, E. Critical thinking in nursing.


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