To explore a strategy of ‘choice’ to enhance critical thinking by allowing the student an option of a clinical report that would best describe the clinical experience for that day.
Critical thinking is a hot topic for nurse educators, both in the classroom and in the clinical setting. Critical thinking is crucial for nursing practice (Papathanasiou, Kleisiaris, Fradelos, Kakou, & Kourkouta, 2014). The clinical setting is fundamental in the development of critical thinking because it is the milieu where nursing students connect clinical practice, begin professional socialization, and test intellectual concepts in an unpredictable environment (Zarshenas et al., 2014). Critical thinking, originally defined in the Delphi Report (Facione, 1990), promotes multiple senses to derive the best answer. While Benner (2015) differentiates clinical reasoning from critical thinking as the ability to include specific patients or families in the clinical setting, Sommers (2018) and Perez et al. (2015) concur that within nursing there are numerous definitions of critical thinking with varying conceptual frameworks. A literature search was conducted and different types of clinical strategies to promote critical thinking where ascertained. Some of these strategies include case-based learning (Forsgren, Christensen, & Hedemalm, 2014); written or narrative (Marchigiano, Eduljee, & Harvey, 2011); scenario-based learning (Lisko & O’Dell, 2010); care plans (Atay & Karabacak, 2012); problem-based learning (Kong, Qin, Zhou, Mou, & Gao, 2014); research (Whiffin & Hasselder, 2013); and promotion of self-accountability with students responsible for their own learning (Spínola & Amendoeira, 2012).
Clinical instructors need to create environments conducive for students to reflect, create, and build confidence, thereby allowing the student to identify, develop, and implement strategies that encourage critical thinking skills (Dos Santos Martins Peixoto & Dos Santos Martins Peixoto, 2017). The typical focus of the nursing curriculum is content delivery and the display of clinical nursing skills. Instructors need to be able to think outside the box. To encourage critical thinking, the student must be able to effectively analyze, problem solve, and make decisions (Facione, 2009).
Methods:
This informal study was conducted over a period of three academic years, with 83 senior I students in a children’s health clinical. There were six topics to choose from, including ‘reflection’.
Results:
Only 34% of students selected the “reflection” or journaling type clinical reports that they were traditionally accustomed to completing in other courses. Thus, 66% of students selected different representation of their learning experience. The choices and their ranking were (a) care plan (2%); (b) epidemiology assessment (32%); (c) disease process assessment (21%); (d) evaluation of inpatient/family education (8%); (e) reflection (34%); and (f) protocol/order set review (3%). Post-conferences were insightful and engaging as students shared their clinical reports. Students were encouraged to ask questions and add comment that promoted critical thinking among the whole group.
Conclusion:
Allowing a ‘choice’ transformed the student by contributing to positive outcomes of autonomy, empowerment, and motivation. The students’ evaluations of the instructor were exceptionally positive and suggested that other courses should adopt this strategy. Overall, comments were extremely encouraging with students expressing greater understanding through critical thinking.