Caring behaviours directly and indirectly affect nursing students' critical thinking
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Updated: Mar 1, 2026

Using Learning Outcome Measures to assess Doctoral Nursing Education
Published on: June 21, 2010
Shu-Yueh Chen1, Hsing-Chi Chang2, Hsiang-Chu Pai3
1Department of Nursing, Hung Kuang University, Taichung City, Taiwan.
Objectives:
The purpose of this study was to determine the effect of caring behaviours on critical thinking and to examine whether self-reflection mediates the effect of caring on critical thinking. We also tested whether caring behaviours moderated the relationship between self-reflection and critical thinking.
Methods:
For this descriptive, correlational, cross-sectional study, we recruited 293 fifth-year nursing students from a junior college in southern Taiwan. Data were collected in 2014 on critical thinking, caring behaviours and self-reflection with insight using the Taiwan Critical Thinking Disposition Inventory, a Chinese version of the Caring Assessment Report Evaluation Q-sort, and a Chinese version of the Self-Reflection and Insight Scale, respectively. Relationships among variables were analysed by structural equation modelling, with the partial least squares method and Sobel test.
Results:
The results showed that caring behaviours significantly positively affected critical thinking (β = 0.56, t = 12.37, p < 0.001) and self-reflection with insight (β = 0.54, t = 11.99, p < 0.001). Self-reflection and insight significantly positively affected critical thinking (β = 0.34, t = 6.48, p < 0.001). Further, self-reflection and insight mediated the relationship between caring behaviours and critical thinking. Caring behaviours did not, however, moderate the relationship between self-reflection (β = 0.001, t = 0.021, p > 0.05) and critical thinking.
Conclusion:
Caring behaviours directly affect self-reflection with insight and critical thinking. In addition, caring behaviours also indirectly affect critical thinking through self-reflection and insight.
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