Graduate nurses: critical thinkers or better decision makers?

Abstract

This study evaluates the difference in development of critical thinking across four groups of nurses at different stages of the academic process and their perception of their decision-making ability in practice. With the move of nurse education into institutes of higher education nationally, there are no empirical data in the UK to suggest that graduates practice any differently from their non-graduate colleagues. An opportunistic sample of 82 nurses, was chosen from recent admission on a pre-registration degree programme, to mature graduates, as well as a group of experienced, non-graduate practitioners. A quasi-experimental, between-subjects design was used. A series of one-way ANOVAs was used to analyse the difference in critical thinking across all four groups, employing the Watson-Glaser Critical Thinking Appraisal. Additionally, the Jenkins Clinical Decision-Making in Nursing Scale was used to determine the differences in decision-making ability in practice across three of the groups with clinical experience. Furthermore, a correlation was undertaken to determine what relationship, if any, existed between critical thinking and decision-making in practice. It was found that there was no significant difference in the critical thinking skills across all groups studied, supporting the findings of other studies in the USA, which examined the cognitive skills of students undertaking graduate programmes. However, in their practice, it was found that those exposed to the academic process were significantly better at decision-making than their non-academic colleagues. Finally, no relationship could be found between the development of critical thinking and decision-making in practice, suggesting that more work needs to be done to look carefully at both critical thinking skills and decision-making in practice and the tools used to measure these.

The Illusion of Competency Versus the Desirability of Expertise: Seeking a Common Standard for Support Professions in Sport

“…For example, at the time of writing the British General Medical Council set 16 ''outcomes'' that must be realised in the 5,500 h of training required for doctors [22]. Acknowledging that single, correct solutions can rarely be prescribed-as practitioners cope with uncertainty and dynamic challenge in complex and individual ways [4]training and evaluation in this setting is, therefore, inherently thematic [5,6]. In contrast, qualification as a UK Level 1 sports coach (capable only of assisting other coaches) requires development and assessment of some 18 ''competency units'', each with numerous sub-divisions, in a 33-h period [7].…”

“…what jargon terms were and were not essential and why, or the need for declarative knowledge in certain kinds of learner) would be required, further increasing the candidate's ability to make judgments and adapt in different situations to that presented as the test environment Competency Versus Expertise in Support Professions in Sport 5 [4,27]. Such approaches would seem essential if trainees are to go beyond clear knowledge that X means Y towards the more subtle blending and elaboration necessary for professional practice [51].…”

“…2 of this paper. Expressly, however, and extending beyond the general response to general challenge patterning of competencybased models, this expertise/competence focus is grounded in the assumption that a multiplicity of solutions often exist for particular problems and that optimum solutions often require specific or even idiosyncratic blends [4][5][6]. Given that professional bodies must develop practitioners for complex and multifaceted environments, we argue that an elevation in the standards and reputation of sport science and coaching, as well as the efficacy of their interactions, requires a greater emphasis on expertise than currently afforded.…”

“…Unfortunately, despite this growing awareness, the positive examples set by medical disciplines (e.g. Girot [4,6] and the General Medical Council [4,6]), and even explicit and detailed coverage of what competence assessment should look like [see Kaslow et al [14] (developed in psychology but, so far in our experience, not followed by sport psychology organisations)], competency models nonetheless remain an industry standard.…”

Measures that can be used to instill critical thinking skills in nurse prescribers

“…Even though the term critical thinking is widely used in nursing literature, adopted in clinical practice (Koch, 1997), in educational programmes (Ribbons, 1998, Loving, 2000 and has been the focus of research projects (Girot, 2000, Ip et al, 2000, Daly, 2001). In the US, Loving, (2000) used Paul's model (Paul, 1995) as a framework for the integration of critical thinking skills in nursing courses.…”