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ABSTRACT
Critical thinking skills are essential to function in today's complex health care environment and to ensure continuing competence for the future. This article provides a review of various definitions and research studies related to critical thinking. Educators and researchers need to clearly define critical thinking, because there has been wide variation in definitions and descriptions of critical thinking. Research studies have shown inconsistent findings, and many have used a one-group pretest-posttest design over a single course or during the length of a nursing program. Studies have not shown an association between critical thinking and competence; rigorous research studies are needed to understand the process of critical thinking.
Today's nursing environment has changed. We have an aging population, increased sociocultural diversity, more acutely ill patients suffering from chronic diseases, decreased financial resources, more sophisticated technology, an emphasis on health promotion, and increased focus on ambulatory and home health care (Cascio, Campbell, Sandor, Rains, & Clark, 1995). To provide quality care in this environment, nurses need to develop critical thinking (CT) skills that will provide them with expertise in flexible, individualized, situation-specific problem-solving.
Nursing education strives to develop CT abilities in students through emphasis on process, inquiry, and reasoning. CT is a central competency in nursing education programs at all levels, although experience and knowledge should reasonably be expected to increase the level of sophistication students are able to bring to the process and the context in which they can apply that process (Applegate, 1998). However, in the applied discipline of nursing, nurses need to reflect on their practice, learn from it, and build on that learning in their future practice (Jarvis, 1992). This is consistent with Benner's (1984) novice-to-expert theory.
Some evidence shows that educators are not doing well teaching and assessing CT skills (Adams, 1999; Hickman, 1993; Kintgen-Andrews, 1991; Rane-Szostak & Robertson, 1996). General themes are lack of a clear definition and problems with tools used to assess CT (Adams, 1999; Rane-Szostak & Robertson, 1996), lack of research showing that nursing education contributes to CT (Hickman, 1993), and an unclear relationship between CT and clinical judgment (Kintgen-Andrews, 1991). Although nursing education programs have recognized the importance of developing nursing students' ability to think critically (National League for Nursing Accreditation Commission [NLNAC], 2000a), CT...