Developing Critical Thinking in the Nursing Student Using Simulated Online
Clinical Scenario Assignments
Susan Longacre
City College of San Francisco
Critical thinking in nursing is essential for providing a high level of patient care in
complex health care environments. Community college nursing students frequently
need assistance developing not only basic nursing skills but higher levels of reasoning
and critical thinking required in the clinical setting. As nurse educators, we need to be
developing additional methods to meet our learning objectives within an environment of
limited resources. This research project investigated whether simulated online clinical
scenarios, offered in conjunction with nursing theory instruction and clinical internship
hours, enhanced critical thinking skills.
The study used a convenience sample of third semester nursing students in Nursing 53,
Maternal/Newborn Nursing at City College of San Francisco. Students were enrolled in
one of two sections; a control group and an experimental group which completed
simulated online clinical scenarios. All students completed a critical thinking assessment
instrument on the first day and the last day of class. A formal survey was also
administered to the experimental students to examine the students’ perceptions of using
the scenarios assignments as a learning tool.
Multiple clinical scenario assignments were developed that consisted of text and picture
files describing and showing a patient in a clinical setting, requiring the student to make
complex assessments and clinical decisions. For each online assignment, students
interpreted the data provided, answered patients’ questions, identified pertinent nursing
diagnoses, and described appropriate nursing actions and/or further assessments. The
students submitted their written responses to the assignments via WebCT. Each
assignment was reviewed by a faculty member from the course. The assignments were
graded and in-depth personalized feedback was provided to each student, helping the
student with the critical thinking competency self-regulation. The feedback would vary
from reinforcing the correct and complete responses, correcting students’ wrong
interpretations, pointing out additional areas needing nursing care, and/or directing
students to review specific portions of the class textbook. The assignments were
returned to the students via WebCT with grades and comments.
The performance of both groups improved significantly over time; however, the
experimental group showed a larger improvement in mean critical thinking test scores
from pre-test to post-test (89% vs 74%). The experimental group also experienced
greater gains in scores, showing a mean test score improvement of 3.5, whereas the
mean difference in the control group was 2.0. The experimental group demonstrated a
larger increase than the control group in four of critical thinking competencies:
Interpretation, Analysis, Explanation and Self Regulation. For the competencies
Evaluation and Inference, the control group has a mean increase of 0.3 while the
experimental group has a mean increase of 0.2.
Over 90% of the students either agreed or strongly agreed that the assignments helped
them develop skills related to the critical thinking competencies. Although students
were not informed that this project was to study critical thinking, several wrote that
completing the assignments helped them with critical thinking.
Students in the experimental group had positive comments about the assignments and
devoted considerable time to them; 33% reported spending five hours or more on each
assignment. This is surprising considering how busy the average community college
nursing student is and the amount of time required for each assignment. Students also
expressed satisfaction with computer based instruction via the WebCT online course
management system because it allowed them to complete the assignments with
flexibility and privacy.
Students in the experimental group found the faculty feedback valuable in their own
professional development. Often in the clinical internship setting, the faculty feedback
to the student is sporadic, based on the acuity of the patients and the student load of
the clinical faculty. Students may not receive detailed and comprehensive feedback until
the end of the course rather than after each individual patient. Possibly the consistent
feedback was helpful in developing the students’ critical thinking skills in the clinical
setting.
Further research may determine which component of these clinical scenario assignments
improved the students’ critical thinking skills. Was it the technology tool, multimedia,
the faculty feedback, describing nursing diagnoses and nursing interventions, the
patient’ question, or possibly all of these factors combined? Computer based instruction
continues to grow at a rapid pace and there are many programs available for nursing
education. Further research is needed to determine if the technology of computer
based instruction helps to develop the nursing student’s critical thinking ability and what
the role the other factors have, such as faculty feedback or answering patients’
questions.
Too view a copy of the entire monograph, go to:
http://www.cccone.org/scholars/05-06/Susan%20Longacre%20Monograph.pdf