Developing Critical Thinkers Through the Use of A.V.I.D. Discussions

For schools of nursing a common essential outcome for their programs is the ability to develop critical thinkers. The need for critical thinkers in the current healthcare environment cannot be overstated (Kramer, 1993), with some identifying, the need being essential to decreasing errors of judgment that can lead to patient death (IOM, 2004). In 2015, the National League for Nursing (NLN) identified the technique of debriefing as a strategy that has the potential to foster critical reflection further asserting that critical reflection is central to being critical. In the 2015 call to action the NLN declared the need to integrate debriefing across nursing curriculum for its potential to transform nursing education. Prior to NLN’s call to action the act of debriefing or engaging in critical reflection was predominantly used in simulation though clinical nurse educators would employ a type of debriefing strategy in their post-clinical discussions. Within the context of clinical learning, traditionally students and faculty engaged in face to face discussions with the intended outcome being that students engaged in critical reflection. The purpose of these post-clinical discussions was to permit students to reflect upon their day engaging in an exchange of ideas between themselves and faculty (Gaberson & Oermann, 2010). The concern for nurse educators however are issues of student fatigue, time constraints at end of day, lack of available clinical space to conduct face to face debriefings, and student’s own need for more time to process their clinical experience as barriers to full student participation in the reflection process (Neumeier & Small, 2014). The purpose of this study was to explore the use of active, varied, interesting, and open-ended discussion (A.V.I.D) questions (Pollack, 2017) as a debriefing method in an online environment in order to improve the critical reflection process and develop the skills and habits of the mind of critical thinking as defined by Scheffer and Rubenfeld (2000). By implementing post-clinical discussions online (Mahoney, Marfurt, daCunha, & Engebretson, 2005; Moran, 2005), it was anticipated that the identified concerns of a more traditional post-clinical format would disappear leaving room for improved student engagement in the debriefing process thus leading to increased critical reflection and critical thinking. Findings indicated that while students were satisfied with an online format, their ability to demonstrate increased skills or habits of the mind related to critical thinking remained essentially unchanged. Further research needs to be implemented using the A.V.I.D method with increased attention to integrating the skills and habits of the mind of critical thinking when developing discussion questions in order to more fully evaluate the method’s ability to provide a meaningful learning experience for the student.