The relationship between critical thinking and clinical decision-making of seniors in baccalaureate nursing programs

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Free, Kathleen Walsh
Brigham, Carole J.
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Thesis (M.S.)
School of Nursing
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Interest in developing critical thinking skills in nursing students has grown in proportion to the demand for thoughtful, capable nursing professionals in healthcare. The National League for Nursing has required schools of nursing to combine teaching styles and course content to develop critical thinking, decision making, and independent judgement. Limited research has been done regarding the relationship of critical thinking ability to clinical decision-making. The purpose of this study was to determine the relationship between these two variables, using a sample of senior baccalaureate students in four schools of nursing.Two research questions were addressed: What is the relationship between critical thinking and clinical decision-making of senior baccalaureate nursing students? and, what is the relationship between selected demographic variables and critical thinking and clinical decision-making in senior baccalaureate nursing students?McPeck's (1981, 1990) critical thinking theory, which guided the study, emphasizes consideration of multiple factors in reaching a decision, toleration of differing conclusions, and the importance of teaching and evaluating critical thinking within the context of a discipline. Critical thinking was measured by the California Critical Thinking Skills Test (CCTST, Facione, 1993), a standardized, 34-item, multiple choice test which targets critical thinking skills. Test items are designed to be discipline-neutral and jargon-free, and have a Kuder-Richardson internal reliability coefficient of .70. Judgement in making clinical decisions was measured by the Nursing Performance Simulation Instrument (NPSI, Gover, 1970), which is composed of four simulations that depict typical nursing situations and test problem-solving proficiency. Six-month test-retest reliability of the NPSI was found to be r=.63. Demographic information on age, gender, GPA, number of completed college credit hours, healthcare work experience, healthcare licensure was collected from subjects.The sample included senior baccalaureate nursing students from four universities (N=88). Nursing faculty at each site was contacted before testing for approval to administer the exam to students. Informed consent was obtained from each subject, and students were able to withdraw from the study at any time. Verbal instructions were given to subjects, and confidentiality was insured by the use of a number identifier on each test. The instruments were administered by, and remained in, the possession of the researcher. Results obtained were reported to test sites as group data only. No risks or benefits were identified in participation in the study.Data analysis was done by a combination of methods, using Pearson product-moment analysis, t-test procedures, and canonical correlation. Results indicated that no relationship existed between critical thinking and clinical decision-making, as measured by the CCTST and the NPSI. The only statistically significant relationship was a weak positive correlation between age and performance on the NPSI. Canonical correlation analysis indicated the older subjects, with a lower GPA and, to a lesser extent, fewer credit hours tended to score higher on the NPSI and lower on the CCTST.The study was significant, in that the results will broaden the knowledge of the relationship between critical thinking and clinical decision-making in nursing.