Critical thinking in nursing education: addressing the theory-practice gap

August 2015 Vol 15 (4)

OPINION: Nursing lecturer Jed Montayre argues nursing education could do better in teaching that critical thinking skills aren’t just needed for written assignments but also to provide safe and effective nursing care.

Jed MontayreThe ability to critically process information to make sound nursing decisions is an important skill that nurses acquire through years of experience.

The framework for nursing education means nursing training is not typically delivered like other professional degrees and includes an enormous practical component during which a student hones their knowledge and skills. Every nursing school aims to provide the best quality learning experience to their students.

Nursing education also has a significant role in preparing students for the challenges beyond the four walls of the lecture theatre or simulation lab and out into the real world of nursing. So activities encouraging critical thinking skills are integrated into the nursing curriculum. 

Critiquing in theory and practice

The term ‘to critique’ is a popular and commonly used instruction in education. It comes from an ancient Greek word, which means ‘faculty of judgment or ability to discern’.

In nursing practice, to critically assess, observe and examine patients are all equally important to providing safe nursing care. However, in nursing education, the task of critiquing an article (or writing a critical analysis of something) is not always a concept well understood by students.

During their nursing training, students are assessed on how they are progressing in acquiring critical thinking skills and the ways to capture this progress is multifactorial. However, some research suggests there are students who can effectively critique theoretical knowledge but may not use those same critical thinking skills in their actual nursing practice. Whether this research is correct or not, the concept of thinking critically and applying critical thinking has a huge bearing on nursing education. Most believe that a nursing curriculum that emphasises critical analysis in its learning activities should produce better students with advanced levels of knowledge and skill. This might be true but it is questionable how much critical thinking is really imparted to nursing students during their years of study. Additionally, how well do schools track students’ progression towards being critical thinkers?

Over the years, the models and frameworks for nursing education have changed. The drive for evidence-based nursing practice requires complementary evidence-based teaching and learning. Being well informed about research is one way of facilitating the critical thinking approach to delivering a nursing education programme. However, academics must be ready to counter the challenges when students are not receptive to, or resist, this way of promoting learning. Assignments that require students to critique a research article or to integrate readings from their research findings into an essay are a good way of developing students’ critical thinking skills. Students also need to know that these skills they build academically can be applied practically. Consequently, nursing lecturers need to stress that critical thinking is not just for academic essays but also transcends to practical nursing work. This message can then be reinforced during practical sessions in simulation labs and clinical skills sessions.

Just another essay?

While most nursing schools do stress critical thinking skills, what seems lacking is an emphasis on effectively linking critical thinking skills in theory and in practice; that is, the ability to critique theoretically and apply learned critical thinking skills to practice. One issue hindering this process is the students’ focus on examinations or assessments, instead of the learning that comes with the course. Also crucial to the process is the value students place on their written assignments and what they have learned from them. Students’ realisation of ‘where to from here’ rarely occurs if they view assignments as mere events or requirements they must undertake to pass or gain a merit mark. Recent UK research suggests that students don’t even really care if they receive written feedback on their assignment or not (unless they fail and then they want to know why).

These are not solely student-driven issues as academics also contribute to this process. I believe that strengthening the link between written assessments and practical nursing work needs to be done in a way that harnesses our natural ability to learn to think critically. This could be done by giving students activities that stimulate their critical learning skills through emphasis on problem-solving, real life scenarios.

By critically analysing events in everyday life, humans can develop their critical thinking skills. Students encounter real patient situations in the clinical environment and they look after real patients during their clinical placement, but most of them have difficulty articulating why things were done the way they were. It is this awareness of the rationale for doing things in nursing that gets missed, probably because there is a gap in emphasising the transition of theory into practice; or it could be that not all students appreciate the value of theoretical knowledge as applied to practice.

Anecdotal reports suggest students also have differing views on the usefulness of written assignments, with some saying they do not stir their interest or relate to the real nature of the profession; instead they regard these types of assessment as mere paperwork to be passed. Whether this is true or not, it makes perfect sense to try and better match up students’ learning perceptions and the kind of assessments crafted and integrated into the nursing programme.

Most importantly, we need to prepare them to link the learned theory to practical skills. This is most effective if critical thinking skills are cultivated in both theory and practice and an emphasis is placed on the ability to critically synthesise theoretical knowledge as applied or observed in practice. This is the key to critical thinking in real life nursing scenarios, which informs sound and safe nursing care. :

Author: Dr Jed Montayre RN DPS (Doctor of Professional Studies) DipT is a nursing lecturer at AUT’s school of nursing.

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