Search terms used for searching each of the above databases were categorized into three main categories: a descriptors of the thinking process, including critical thinking or deep-level thinking; b terms associated with nursing and nursing educational contexts; and c identifiers for the target population of nurse educators, faculty members, and nursing instructors.
To retrieve literature for this review, the databases were searched as described above. In addition, the authors a examined Web sites specifically related or linked to critical thinking or nursing education; b reviewed reference lists of articles to ensure that research-based articles were not missed; c searched, by hand, three key nursing education journals the Journal of Nursing Education , Issues and Innovations in Nursing Education , and Nurse Educator to retrieve any additional articles not captured in the database and reference list searches; and d held discussions with local experts.
To be included in this integrative review, articles or dissertations had to be dated from to ; be written in the English language or have a detailed English language abstract available; be primary sources of quantitative or qualitative research; and contain a description of the research that was completed to measure or conceptualize academic nurse educators' critical thinking definitions, skills, or dispositions, or a combination of these.
Exclusion criteria for this integrative review included non-English dissertations or articles without a detailed English abstract available, theoretical-related literature, research articles that related to nursing programs not aimed at RN education e. The above inclusion and exclusion criteria were based on the need to locate literature that best answered the questions posed for this review and was published within the time frame most likely to retrieve current yet applicable articles.
For example, articles published prior to would be based on research completed in earlier contexts that may not translate into current practice. The synthesized results from older articles would not be applied as readily to the current context of nursing education; therefore, they were not part of this review.
To reduce publication bias in this review, dissertations were included as potential research sources, given the large number available and the trend in this field whereby dissertations are often not published, despite their valuable information and findings. Databases and hard copies of journals were searched for articles and dissertations that met the inclusion criteria. The Figure depicts the search and retrieval process. From the search and retrieval process, many potential articles and dissertations were identified i.
An Integrative Review of the Concealed Connection: Nurse Educators' Critical Thinking
Because the review was focused on a specific subset of nursing education studies e. There were many theoretical articles that were retrieved but not included in this review, as well. Data were extracted from each article, including reference information i. Although blinding of those extracting the data from articles is valuable, this was not done for this review due to financial restraints.
See Table A available in the online version of this article outlining the extracted data. A quality assessment of included articles and dissertations for this review was completed, which was subsequently double checked by a co-author J. Due to the small number of articles and dissertations located on this topic, no cut-off level of quality was used to decide whether to retain or discard the article or dissertation from the review. Instead, criteria were used to compile trends extracted from the articles and dissertations and to substantiate the need for further work on reporting research studies in this area.
All quantitative and qualitative research articles and dissertations included in this review were analyzed for quality using criteria from the STROBE S trengthening the R eporting of O bservational S tudies in E pidemiology statement for observational studies, as well as Mays' and Pope's qualitative study review criteria.
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A combined analysis tool was used to compile the results for both types of research studies. See Table B available in the online version of this article outlining the main points from the quality assessment of the articles and dissertations. Based on the extracted data and the quality assessment of each study, the authors offer their analysis to the guiding questions, posed at the start of this review.
Question one: Over the past 15 years to current , how have nurse educators' critical thinking skills or dispositions been measured or explored in nursing education?
Since , nurse educators' critical thinking has not been studied extensively. Only 10 studies were located for the review period; six of these studies were published in peer-reviewed journals, and four were dissertations. One of the articles was part of a dissertation; thus, the results reported in the publication and dissertation Blondy, , were counted as one study. Of note, studies included in this review that were published closer to were more focused on establishing nurse educators' conceptions of critical thinking, whereas later studies focused on understanding how to measure nurse educators' critical thinking.
The authors of the current study explored the research designs, data collection methods, and sampling practices to help demonstrate how nurse educators' critical thinking has been analyzed over the past 15 years. Four research studies included in this review were conducted solely in the United States, two were conducted in Canada, and one was conducted in New Zealand, as well as Thailand and the United States simultaneously.
As evident in the extraction table Table B , both quantitative and qualitative studies were identified that examined nurse educators' critical thinking in the time period of to The quantitative studies used primarily descriptive or correlational designs. However, three of the six primarily quantitative studies used both qualitative and quantitative data gathering approaches, which points to the growing understanding that both quantitative and qualitative research methods are needed to understand nurse educators' critical thinking.
An expanding use of qualitative research methods to study nurse educators' critical thinking also was observed. The qualitative-based research articles and dissertations included in this review used interpretive designs. A variety of tools were used in the examined studies.
The researchers who completed the qualitative studies used predominantly interviews as their data collection method. One study also used observations and document reviews Hobus, Sample sizes of the included articles and dissertations ranged from one to participants. However, seven of the 10 articles or dissertations reported study samples composed of fewer than 50 participants. The most popular sampling technique in the group of quantitative-based studies was one of convenience; some used purposive techniques, whereas only two studies used randomization.
Question two consisted of: What do studies published from to , examining nurse educators' or students' critical thinking, tell us about how critical thinking exists in the nurse educator population?
Three themes were identified from the analysis: a variation of critical thinking definitions, b a multitude of barriers and facilitators of nurse educators' critical thinking, and c important contextual factors influencing critical thinking in nursing education. Scheffer pointed out the nonuniformity of critical thinking definitions in nursing and noted that nurse educator participants infrequently cited published definitions of critical thinking. The choice and use of critical thinking definitions underpinning the research were varied.
Authors of four of the 10 articles or dissertations specified a particular definition on which they based their research. Three of the four authors who included a critical thinking definition to guide their work chose Facione's definition. Authors of the remaining studies did not provide any rationale as to why they omitted a definition.
Some studies offered a traditional view of critical thinking, in combination with the essential nature of attitudes and dispositions Walthew, Gordon found nurse scholars, when compared to non-nurse scholars, were less likely to agree that interpretation was a component of critical thinking and more likely to regard decision making and problem solving as similar or the same as critical thinking. In addition, participants in Goyne's study identified intuition and subjective knowing as part of critical thinking.
Goyne also identified that critical thinking could be subcategorized into purpose elements to help in decision making, problem solving, and outcomes , knowledge elements arising from nursing knowledge and experience , and process elements application of both skills and dispositions.
Jenkins identified the importance of cultural and geographical differences in definitions of critical thinking. Participants from Thailand identified a strong link between happiness and critical thinking, whereas those from the United States suggested decision making was a stronger component of critical thinking. In addition to the various definitions within the literature selected for the current review, authors also discussed the barriers and facilitators of critical thinking. Raymond and Profetto-McGrath identified individual factors, such as health and dispositions, aiding in one's critical thinking.
Blondy added decreased knowledge and time as additional individual barriers. The effects of context on the actualization of critical thinking was another factor evident in the reviewed studies. Jenkins concluded that one cannot separate nursing knowledge from critical thinking in nursing.
That is, the nursing context, influenced by culture, influences the definition and usage of critical thinking. Walthew further identified the fundamental importance of context, relationships, and emotions on critical thinking. An additional link between context and critical thinking was recognized by Goyne , highlighting the role of nursing-specific knowledge and experience on the thinking process. The authors of the current study also found that each individual educator has an affect on the context in which critical thinking occurs. For example, Hobus identified the individual and contextual nature of critical thinking and the role that life and educational experiences have on its development.
Given the unclear nature and generalizability of critical thinking skills and abilities, understanding the specific individual and contextual factors is an important step to understanding the complexity of critical thinking. By not having a consensus definition or important discussion around what definitions are applicable to nursing, how critical thinking articulates with the nursing context remains vague. The results from the quantitative research studies included in this review were informative, with some notable differences and notable similarities.
This is understandable, given that the published norm at that time was based on college-level student scores. In addition, in each of the three studies, the analysis subscale scores demonstrated strong or almost strong for all mean scores. The results of the other CCTST subscales mean scores for all three studies were ranked moderate, with no weak subscale mean scores noted. In the study by Raymond and Profetto-McGrath , the highest scores were achieved on the inquisitiveness subscale, whereas the lowest three sub-scale scores were analyticity, truthseeking, and systematicity.
Profetto-McGrath et al. However, the order of the lower three subscales in the latter study differed slightly i. Overall, both studies reported a CCTDI mean total score greater than , indicating participants' similar overall positive inclination to think critically. A comparison between studies was difficult, given that none of these tools were found in more than one study. Nevertheless, some significant and insignificant correlations were reported with the use of the above measures.
Blondy established a significant link between education level and the number of barriers educators experienced using a researcher-developed barrier measurement tool. These correlations require further replication to understand their significance. There were limited definitions or conceptual frameworks included in the reviewed studies.
Many studies examined how best to conceptualize critical thinking, which may have underscored the omission of a preconceived definition. The quality of the studies also was assessed in the review. It was difficult to determine the quality of most studies, owing to the limited reporting of many details.source
Facilitating Critical Thinking
Missing details often included the identification of the research design in either the abstract or title, lack of research questions, and limited discussion of the reliability and validity i. It is worth noting that the dissertations included as part of this review were more detailed than the articles, which may have positively skewed the results of the quality assessments. Limitations of this integrative review include the potential for language bias, given that this review only included articles and documents written in English.