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Health care organizations have made dramatic advances and transformations during the last three decades, resulting in the rapid growth of technology and theory (Edwards, 2003 ). If nurses are to deal effectively with such complex changes, they must become skilled in higher-level thinking and reasoning abilities. It is essential for nurses to develop critical thinking skills to ensure their ability to provide safe, effective care to patients with complex and variable needs in ever-changing clinical environments. In the intensive care unit (ICU), nurses provide highly specialized care to severely compromised patients. New graduate nurses require customized orientation to the ICU practice environment (Graham, Hall, & Sigurdson, 2008 ).
In some hospitals, didactic orientation programs, facilitated by nurse educators, have recently been changed to adopt the American Association of Critical Care Nurses (AACN) Essentials of Critical Care Orientation (ECCO) program to help novice nurses transition into critical care nursing. Most nursing programs strive to promote critical thinking skills among nurses. No matter what type of nursing education these nurses receive, critical thinking skills are crucial in the professional preparation of nurses, who need to think critically to be competent, safe, and skillful providers of care (Commission on Collegiate Nursing Education, 2006 ).
Background and Purpose
Critical thinking has become a goal in most nursing organizations. Research has suggested that many new registered nurses often have difficulty thinking critically in clinical practice, especially in situations requiring quick, accurate decisions and actions (McConnell, 2008 ; Shell, 2001 ; Welk, 2002 ). Hospital-based nurse educators should include in their orientation programs strategies to facilitate the development of critical thinking skills in nurses. A recent hospital-based orientation program is the ECCO program, which was first released in 2002 by the AACN. The AACN produced the ECCO content. The ECCO program has recently been adopted by various hospitals (AACN, 2009 ).
The ECCO program is an online (web-based) nursing educational program that consists of content modules presented with a body systems approach, with accompanying self-assessment checkpoints and multiple-choice examinations to evaluate learning and verify a nurse's level of concept mastery (AACN, 2009 ). The modules include basic principles of critical care nursing, with a specific focus on how these principles could be applied to...