Critical thinking skills are essential to function in today's complex health care environment and to ensure continuing competence for the future. This article provides a review of various definitions and research studies related to critical thinking. Educators and researchers need to clearly define critical thinking, because there has been wide variation in definitions and descriptions of critical thinking. Research studies have shown inconsistent findings, and many have used a one-group pretest-posttest design over a single course or during the length of a nursing program. Studies have not shown an association between critical thinking and competence; rigorous research studies are needed to understand the process of critical thinking.

Health care professionals must use critical-thinking skills to solve increasingly complex problems. Educators need to help nurses develop their critical-thinking skills to maintain and enhance their competence. This article reviews various models of critical thinking, as well as methods used to evaluate critical thinking. Specific educational strategies to develop nurses' critical-thinking skills are discussed. Additional research studies are needed to determine how the process of nursing practice can nurture and develop critical-thinking skills, and which strategies are most effective in developing and evaluating critical thinking.

Workplace violence in health care settings is increasing dramatically nationwide. In response, an interdisciplinary team at an Ohio health system developed and piloted a model of training to address workplace violence. The model included classroom learning, a code silver (person with a weapon or a hostage situation) simulation training, and hands-on self-defense techniques. Based on data collected in the pilot, the team revised the model to offer a more comprehensive approach; the new, revised training program is known as Violence: enABLE Yourself to Respond. The team designed four distinct five-minute simulation scenarios depicting a range of threats from “escalating behavior” to “active shooter” and enacted them with standardized participants (health care personnel trained to perform specific behaviors in educational scenarios). Immediately after each simulation, the instructors facilitated a debriefing of the participants. Participants' pre- and post-training program self-evaluations of how prepared they felt to react to violent situations, as well as experts' evaluations of the participants' performance in simulations, provided evidence of the effectiveness of the model. Analysis of the data demonstrated a statistically significant positive difference in both participants' perception of their preparedness and experts' evaluation of their performance. The combination of classroom learning and simulation training is an effective, evidence-based method to prepare employees to respond when a situation escalates to violence, including the use of a weapon. This approach was designed for acute care but can be adapted to other settings. Skills learned can be used in both personal and professional life.

Using the Cervero model of behavior change and questionnaires developed by Brigham, Ryan, and Elkins (1996), this study assessed the impact of a workshop on behavior change. Data on the individual professional (receptiveness), proposed change (feasibility), social system (climate), and program (quality), as well as self-report data about outcomes (expertise and actions) were included. Information on perceived expertise was obtained before the workshop, immediately after the workshop, and 3 months after the workshop. Information on actions initiated by the participants was obtained 3 months after the workshop. There were 70 participants in this study, with a variety of educational backgrounds and nursing experience. A matched test comparing expertise between time 1 and time 2, as well as time 1 and time 3 was significant at p = 0.00. There were significant correlations among the four variables influencing behavior change and actions and expertise. All except one participant in the study reported taking specific actions after the workshop. The mean number of actions taken was 4.0, with a range from 1 to 9. These findings indicate that a continuing education program can lead to behavior change.

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