Critical Thinking Dispositions
This study included 614 newly graduated nurses in Norway, representing a response rate of 33%. This response rate led to a drop-out analysis. A total of 178 nurses responded to questions about age, gender and whether or not they had education at university college level and healthcare experience prior to nursing education. This analysis and the information about age and gender for the study population (N= 2675) revealed that there were no statistically significant differences between these groups with respect to the background variables. This is an aspect of internal validity, and contributes to strengthening the results. One reason for the low response rate may be the fact that, in addition to the CCTDI, two other questionnaires were sent at the same time (these results will be reported elsewhere). One of these questionnaires was quite extensive. Another possible reason for drop-out may have been lack of interest in the study topic.
In the present study the Cronbach’s alpha value for the total CCTDI was 0·83, indicating a good internal consistency (Burns & Grove 2001). This is in line with the findings of other authors using the CCTDI outside the United States of America (USA) and Canada (Ip et al. 2000, Tiwari et al. 2003, Ozturk et al. 2008). Our alpha values for the subscales varied between 0·46 and 0·72. Low subscale values have also been reported by other authors (Leppa 1997, Ip et al. 2000, Tiwari et al. 2003, Ozturk et al. 2008). Kawashima and Petrini (2004) suggested in their Japanese study that low Cronbach’s alpha values might be as a result of cultural biases. Even though the Norwegian culture is thought to be more like the US culture than the Japanese, cultural bias might also have affected findings in the present study. We recommend more studies using the CCTDI in a European context to test the reliability further in this context. Regarding external validity, cluster sampling was used, as the colleges graduating the nurses included in the study were chosen by drawing lots (Figure 1). Cluster sampling is a random sampling method and reduces sampling error (Burns & Grove 2001).
Discussion of results
In this study we focused on critical thinking dispositions among newly graduated nurses in Norway and relationships between the background data and critical thinking dispositions. Development of critical thinking dispositions is essential to enable newly graduated nurses to function as professional nurses (Thorpe & Loo 2003), and an ideal critical thinker has been described as inquisitive, well-informed, open-minded, willing to reconsider and orderly in complex matters (Facione 1990). This description might well be a description of the ‘ideal’ nurse.
The respondents in this study reported mean overall CCTDI scores indicating a positive inclination towards critical thinking. When comparing our findings to studies including nursing students, our newly graduated nurses scored lower than US and Canadian nursing students (May et al. 1999, Profetto-McGrath 2003), but higher than nursing students from Hong Kong and Australia (Tiwari et al. 2003) and Turkey (Ozturk et al. 2008). Total CCTDI score in the present study was higher than that reported for nurses (the sample included nurses at different educational levels, and some were assistant nurses) in a Canadian (Profetto-McGrath et al. 2003) and Japanese study (Kawashima & Petrini 2004), but lower than those for US nurses (Facione & Facione 1997, Smith-Blair & Neighbors 2000). These findings might reflect the cultural differences mentioned above.
The highest subscale mean score (48·0) was found on the Inquisitiveness subscale. Here nearly 90% of the nurses were positively disposed (i.e. had scores above the cut-off score of 40), which is in line with other studies (May et al. 1999, Smith-Blair & Neighbors 2000, Profetto-McGrath 2003). This subscale measures intellectual curiosity and desire for learning. A deficit in this respect would indicate a fundamental limitation of ‘one’s potential to develop expert knowledge and clinical practice ability’ (Facione et al. 1994, p. 346), and nurses scoring high on this subscale are motivated to expand their knowledge bases (Smith-Blair & Neighbors 2000). According to Profetto-McGrath (2003), this finding reflects eagerness to obtain knowledge even when it may not have immediate use, a finding that is encouraging and desirable. The disposition towards inquisitiveness among nurses in the present study seems to correspond with findings in a qualitative study including newly graduated nurses, who reported that they looked upon challenges as opportunities for learning (Wangensteen et al. 2008). People who have a strong belief in their capabilities tend to approach difficult tasks as challenges to be mastered (Bandura 1997). Further, nurses who are inquisitive, open-minded and systematic are more likely to use research findings in their work, which may contribute to high-quality nursing care (Profetto-McGrath et al. 2003).
The lowest mean score was found on the Truth-seeking subscale (39·4). More than half of our respondents scored between 30 and 39 on this subscale, and approximately 5% scored below 30, indicating strong opposition in this respect. Low scores on the Truth-seeking subscale may be seen in nurses who are unwilling to re-evaluate new information, and who base their nursing on ‘how things always have been done’ (Smith-Blair & Neighbors 2000). Other authors have also reported the lowest mean scores for this subscale (May et al. 1999, Ip et al. 2000, Smith-Blair & Neighbors 2000, Profetto-McGrath et al. 2003, Tiwari et al. 2003). Further, Walsh and Hardy (1999), who studied students on six academic programmes, reported the lowest mean score (below 40) for the Truth-seeking subscale. This was the case across all six programmes, but the mean score for nursing students was reported to be lowest. As the Truth-seeking subscale targets intellectual honesty (Giancarlo & Facione 2001), i.e. the disposition to be courageous about asking questions and to be honest and objective about pursuing inquiry even when the topics do not support one’s self-interest (Facione et al. 1994), these findings are worrying. The low mean score for this subscale has been explained in several studies by questioning whether nursing programmes still have traditional and strictly didactic teaching strategies (May et al. 1999, Walsh & Hardy 1999, Profetto-McGrath et al. 2003). It would be desirable that newly graduated nurses had higher scores with respect to Truth-seeking, as a higher disposition would indicate a capability to re-evaluate new information and not base practice on how procedures have always been done. Despite low Truth-seeking mean scores, Ozturk et al. (2008) reported statistically significant higher scores for nursing students in a problem-based learning (PBL) model (40·1) compared with those following a traditional educational model (35·8). These authors also discussed the emphasis on questioning and information-seeking skills in the PBL model as a possible explanation for this difference. It would therefore be of interest to study this relationship further. There might be a need for a new curriculum in nursing, with learning models based on active student participation and where critical thinking is an important element (Bevis & Watson 2000). Further, May et al. (1999) questioned whether the standard score for the Truth-seeking subscale has been established at a higher level than might reasonably be expected.
In our study, nurses older than 30 years to a greater extent reported high values on the total CCTDI, as well as on three of the subscales compared with those younger than that age. Tiwari et al. (2003) reported corresponding results for the CCTDI total score for nursing students. Facione and Facione (1997) reported statistically significant correlations between age and several CCTDI subscales (i.e. the older the higher scores), but only with respect to the Truth-seeking subscale was the correlation high enough (r = 0·225) to be noteworthy. Walsh and Hardy (1999) reported no statistically significant gender differences with respect to CCTDI total score or subscale scores. In contrast to findings in some other studies that women scored statistically significant higher than men on the Open-mindedness and Maturity subscales (Facione et al. 1995, Facione & Facione 1997, Giancarlo & Facione 2001), no such gender differences were found in the present study. However, there were statistically significant more males than females with high scores on the Analyticity subscale, a finding in line with that of Giancarlo and Facione (2001). Despite the gender differences reported, Giancarlo and Facione (2001) claim that males and females are notably similar with respect to critical thinking.
In the present study, approximately two-thirds of nurses with university education prior to nursing education reported high scores on the Truth-seeking subscale compared with less than half of those without such education. Pepa et al. (1997), who measured critical thinking by means of the WGCTA, reported that students who had completed 44 college credits prior to nursing education were able to think more critically than those without such education. Comparisons between those with and without university education prior to nursing education have not been found in previous CCTDI studies. Despite the low scores on the Truth-seeking subscale in the present, as well as in others (May et al. 1999, Walsh & Hardy 1999, Profetto-McGrath et al. 2003), our findings indicate that university education prior to nursing education might have an impact on the Truth-seeking subscale. Sixty per cent of our newly graduated nurses had healthcare experience prior to nursing education. This experience, however, did not seem to contribute to their critical thinking.
A greater proportion of nurses working in community health care reported high scores on the total CCTDI compared with the nurses working in hospitals. One explanation for this might be that those working in community health care were older (mean age 32·7) than those working in hospitals (mean age 29·6). Thirty-six per cent of the newly graduated nurses in the present study worked in community health care, an area where the number of patients needing care at a high professional level is increasing (Kalseth et al. 2004). Long-term care nursing is reported to be a complex, demanding and interesting nursing work environment (Leppa 2004), and is also described as being a ‘fast-growing industry’ (Bevis & Watson 2000). Thus, having newly graduated nurses with a positive inclination to be critical thinkers, i.e. inquisitive, well-informed and orderly in complex matters, will be of benefit in community health care.
The present study demonstrated some differences between nurses with high vs. low critical thinking dispositions with regard to background variables as age, gender, university education prior to nursing education and work area. Fero et al. (2009), who studied critical thinking ability among newly graduated and experienced nurses, regretted that this kind of information was not available in their study, recommending those variables to be included in further studies.
Critical thinking and nursing practice
Critical thinking in nursing is an essential component of professional accountability and quality nursing care (Distler 2007), an outcome expected of all graduate nurses (Pepa et al. 1997). Individuals who have developed the disposition for truth-seeking, open-mindedness, analyticity, systematicity, self-confidence, inquisitiveness and maturity are more likely to apply critical thinking in their personal and professional lives (Smith-Blair & Neighbors 2000).
Skills alone do not guarantee success in the workplace, because people must be disposed to use what they have learnt (Facione et al. 2000). This statement is in line with Bandura (1997) concept of self-efficacy, described as a belief about how to manage different situations in different contexts. Nurses who are critical thinkers may contribute to changing health care to improve it (Bevis & Watson 2000). Furthermore critical thinking is reported as vital to evidence-based nursing (Profetto-McGrath 2005). Daly (1998) claims that critical thinking from an interdisciplinary point of view would contribute to sound professional relationships and political awareness, a statement in line with the expectation that nurses should identify themselves as partners in an interdisciplinary team (Krøll & Hansen 2000).
It is not enough to teach students to perform thinking operations and tasks. They should also be disposed to carrying them out on their own, unasked.
Critical Thinking Dispositions
by Robert Ennis
Seek a clear statement of the thesis or question
Try to be well informed
Use and mention credible sources
Take into account the total situation
Try to remain relevant to the main point
Keep in mind the original or basic concern
Look for alternatives
Take a position (and change a position) when the evidence and reasons are sufficient to do so
Seek as much precision as the subject permits
Deal in an orderly manner with the parts of a complex whole
Use one's critical thinking abilities
Be sensitive to the feelings, level of knowledge, and degree of sophistication of others
Source: Robert H. Ennis. "A Taxonomy of Critical Thinking Dispositions and Abilities" in Teaching Thinking Skills: Theory and Practice; eds. Joan Boykoff Baron and Robert J. Sternberg. Freeman, 1987.
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