Thinking in nursing education. Part II. A teacher's experience

Across academia, educators are investigating teaching strategies that facilitate students' abilities to think critically. Because may these strategies require low teacher-student ratios or sustained involvement over time, efforts to implement them are often constrained by diminishing resources for education, faculty reductions, and increasing number of part-time teachers and students. In nursing, the challenges of teaching and learning critical thinking are compounded by the demands of providing care to patients with increasingly acute and complex problems in a wide variety of settings. To meet these challenges, nurse teachers have commonly used a variety of strategies to teach critical thinking (1). For instance, they often provide students with case studies or simulated clinical situations in classroom and laboratory settings (2). At other times, students are taught a process of critical thinking and given structured clinical assignments, such as care plans or care maps, where they apply this process in anticipating the care a particular patient will require. Accompanying students onto clinical units, teachers typically evaluate critical thinking ability by reviewing a student's preparation prior to the experience and discussing it with the student during the course of the experience. The rationales students provide for particular nursing interventions are taken as evidence of their critical thinking ability. While this approach is commonly thought to be effective, the evolving health care system has placed increased emphasis on community nursing (3,4), where it is often difficult to prespecify learning experiences or to anticipate patient care needs. In addition, teachers are often not able to accompany each student to the clinical site. Thus, the traditional strategies for teaching and learning critical thinking common to hospital-based clinical courses are being challenged, transformed, and extended (5). Part II of this article describes findings that suggest how many teachers and students are challenging the conventional approaches to schooling and creating pedagogies that are more responsive to the contemporary context of health care.