Challenges in Fostering Critical Thinking of Students in Developing Countries: Ghana as a Case Study

Purpose:

                    Nurse educators are required to prepare students to address current and future health care challenges. The ability of health care professionals to think critically may directly affect patient safety (Robert & Petersen, 2013).

                    In Ghana, indicators have been identified that lead one to believe that critical thinking is not being exhibited by nurses in caring for their patients (Adjatey, 2013; Adofo, 2010). Students are still taught to follow the functional model of nursing care. This model supports an environment in which nursing service remains task-oriented. This is an obstacle to the development of critical thinking skills.

            Other challenges in the nursing educational system may erode the attempt to develop critical thinking skills of nursing students. Some of these challenges Ghana’s educational institutions must contend with include: limited educational resources; lack of infrastructure, large class sizes, and shortage of nurse educators (Bell, Rominski, Bam, Donkor, & Lori, 2013). These challenges could potentially serve as obstacles to the promotion of critical thinking skills.

Compounding the problems of the educational institutions, there is no specific educational program on critical thinking for nurse educators. Yet, the educator is an essential element for the development of critical thinking skills of the student. These authors are not aware of any published study in Ghana that identified barriers that hinder nurse educators from fostering critical thinking in students. Therefore, the purpose of this study was to identify challenges that hinder nurse educators from fostering critical thinking of students.

            To accomplish the purpose of this study, the following research questions were addressed:

1. What instructional strategies do nursing faculty use to promote the development of critical thinking in students?
2. What are the barriers that hinder nursing faculty from fostering critical thinking in students?

Methods:

            A multi-site descriptive cross-sectional quantitative study design was used in carrying out this study. The study was univariate descriptive and no relationship was studied (Polit and Beck, 2012). Approval for the study was obtained from the University of Cape Coast Institutional Review Board.    Through cluster sampling technique, 106 nurse educators from 11 publicly funded nursing schools in Ghana responded using a self-reported questionnaire. Data were analysed using the Statistical Package for the Social Sciences (SPSS) software, version 16.  Descriptive statistics and factor analysis were used to answer the research questions.

Results:

            The teaching method most frequently used was discussion (75.5%) followed closely by lecture (69.8%). It was surprising that nurse educators reported using discussion most frequently. The authors, having been part of the nursing educational system for close to 10 years, have observed that lecture is the most frequently used teaching method interspersed with occasional question and answer periods. Perhaps, it is these questions and answer periods that the educators considered as discussion methods. Moreover, class sizes in nursing schools in Ghana (often ranging from 50 to 300) do not allow for proper discussions to take place. Some authors have reported that lecture method was the most often used method in the classroom (Billings & Halstead, 2009; DeYoung, 2009).

            The study further identified eight factors that hindered the development of critical thinking in students. These included course structure and materials; lack of institutional framework/support; students’ characteristics; time limitation; faculty limitation; seeing faculty as authority that should not be challenged; encouraging inappropriate learning styles; and desire for good grades. Several authors have reported on some of the barriers to developing critical thinking that were identified in this study. Raymond and Profetto-McGrath (2005) and Shell (2001) reported inadequate time in the classroom as one of the barriers to critical thinking development. Shell (2001) reported student-related barriers as the greatest barrier perceived by nurse educators. Mangena and Chabeli (2005) reported low levels of education as background (lack of needed background) that hindered the promotion of critical thinking. Kowalczyk, Hackworth, and Case-Smith (2012) and Shell reported that students lacked interest in critical thinking activities as one of the student-related barriers. Giving that these studies were carried out in more advance countries as well as the current state of nursing education in Ghana makes one to believe that the barriers may be more profound in Ghana.   

            Other barriers identified by the nurse educators included (1) the educational system in Ghana (from basic to tertiary level) which promoted rote learning (“chew and pour”), (2) nursing care in Ghana being mechanical and not encouraging critical thinking, (3) large class sizes , and (4) lack of continuing professional development programs on critical thinking. The findings that there was limited support from administration and policy makers in the arena of nursing education  indicated that critical thinking is not a priority in nursing education for authorities and policy makers. This is consistent to previous studies by Kowalczyk, Hackworth, and Case-Smith (2012) who presented similar hindrances to the implementation of critical thinking.  In  their study, hindrances included inadequate support from management, and lack of funding for tools to employ critical thinking strategies. In contrast, Raymond and Profetto-McGrath (2005) identified some constructive factors. These included prospects for faculty development, support from administration, liberty to try fresh thoughts, and mentorship. The disparity in the developmental stages of the Canada and Ghana may account for the different results.  

Conclusion:

            Critical thinking is crucial in shaping healthcare providers, especially nurses, to respond to current complex health needs being faced by healthcare systems globally. Critical thinking skills are essential for the nurse in the 21^st century in order to provide safe nursing care that enhances achievement of outcomes. Yet, Ghana’s nursing educational system is faced with numerous barriers to the promotion of critical thinking that hinders good health outcomes. Nursing programs are not adequately preparing nurses with the necessary critical thinking skills required for a dynamic healthcare environment. The authors proposed that continuous professional programs in critical thinking should be instituted for nurse educators.