Using the Nursing Process to Enhance Critical Thinking: A Qualitative Study

Purpose: Traditionally, information is presented to students without giving them the opportunity to apply it (Baron, 2017). As the health care environment is constantly evolving and patient care is becoming more complex, there have been calls for reforming nursing education (Benner, 2010; Institute of Medicine, 2011). Integrating critical thinking strategies into nursing curricula is one method that can be used to meet this need. Facione (1990) defined critical thinking “as the process of purposeful, self-regulatory judgment; an interactive, reflective, reasoning process.” Using critical thinking to apply the nursing process will promote optimal patient care. The nursing process serves as a guide to nursing care using a systematic approach integrating critical thinking, goal orientated tasks, evidence-based practice, and nursing intuition (Toney-Butler & Thayer, 2018). This important process continues to be used as a model today when providing patient care. By providing nurses with a strong knowledge base, the nurse can focus on the patient problem using the nursing process (Ahdellah, 1969). The purpose of this presentation is to report research findings of teaching strategies that use the nursing process to develop critical thinking in the classroom.

Methods: A convenience sample of accelerated second-degree undergraduate nursing students (n=54) were recruited to participate in a qualitative survey when in their final medical-surgical course. This sample was in their second-semester of a three-semester program. Students were expected to watch lectures online of assigned content prior to attending class. Throughout the semester, different strategies were incorporated into the classroom such as case studies, NCLEX question review, virtual simulation, in-class discussions, and patient prioritization exercises. During these activities, students were expected to use the nursing process to guide them in their thinking. At the end of the semester, participants were asked to identify what strategies helped promote the development of their critical thinking skills.

Results: Thematic analysis indicated the in-class exercises helped participants develop their critical thinking skills. Results also demonstrated students were more confident in implementing the nursing process when providing patient care.

Conclusion: Overall, students felt more comfortable in their ability to critically think and apply the nursing process to patient scenarios using active learning strategies. They also felt case studies, in-class discussions, virtual simulation, and patient prioritization exercises enhanced their critical thinking skills. They found employing the nursing process when reviewing NCLEX questions and patient scenarios especially helpful.

As universities become more corporate in their desire to deliver a good product and increase consumer satisfaction, the delivery of teaching methodologies and learning strategies is especially important. Using active learning as a teaching pedagogy was perceived by students as beneficial in enhancing their critical thinking. Quantitative correlation between active learning strategies and actual gains in critical thinking in the undergraduate nursing student population would be further warranted to continue to examine this relationship.