A Narrative Thematic Analysis of Baccalaureate Nursing Students' Nurse-Patient Clinical Reflections

Wednesday, 24 July 2013: 3:50 PM

Jessica L. Naber, RN, MSN, PhD1
Joanne Hall, PhD, RN, FAAN2
Craig Schadler1
(1)School of Nursing, Murray State University, Murray, KY
(2)Nursing, University of Tennessee, Knoxville, Knoxville, TN

Learning Objective 1: The learner will be able to identify characteristics of critical thinking in nursing studentsí reflective writing assignments.

Learning Objective 2: The learner will be able to define themes from nursing student narratives that exemplify critical thinking.

Purpose: The purpose of this study was to identify characteristics of critical thinking in nursing students’ reflective writing assignments, which were guided by Richard Paul's model of critical thinking. The importance of critical thinking as an outcome for students graduating from undergraduate nursing programs is well-documented by both the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN). Graduating nurses are expected to apply critical thinking in all practice situations to improve patient health outcomes. 

Methods: In a previous study, Paul’s model of critical thinking was used as a basis to develop questions for reflective writing assignments. Within this study, students completed six open-ended nursing students' narratives of nurse-patient clinical encounters during an eight-week clinical experience. Following completion of those assignments, improvements were seen in critical thinking scores. This is a report of the qualitative analysis of the content of student responses during the intervention. A narrative analysis approach was used. Researchers open-coded for content and three members of the research team performed repetitive readings of the narratives to enhance rigor. In addition, an audit trail was kept to strengthen the rigor of the study.

Results: From these processes, narrative themes were derived. Each of the themes was defined and exemplars from the data were used to support the credibility of the findings. Sample themes include "Managing Multiple Data Sources", "Recognizing Patterns", and "Correcting Preconceptions".

Conclusion: Identified themes provided information to nursing faculty members so that they could better understand students’ critical thinking abilities and skills. Faculty members' understanding of the characteristics of critical thinking in the context of clinical education will help them be more prepared to teach students to be critical thinkers. The study provides a view of how critical thinking develops in the stories students construct about their clinical experiences.