Thinking in nursing education. Part I. A student's experience learning to think.

Learning to think critically is a central commitment of nursing education. There is a substantial body of literature describing nursing educators' attempts to define critical thinking (1-3) to differentiate critical thinking from other kinds of thinking (1,4), and to measure students' ability (and changes in ability) to think critically (2,5-7). These efforts were facilitated when the National League for Nursing Accrediting Commission (NLNAC) identified critical thinking as an outcome criterion for the accrediation of undergraduate and graduate nursing programs. This change in accreditation led to the proliferation of framework (8,9) and strategies (10,11) for nursing educators to use in demonstrating compliance with this criterion. Describing strategies and frameworks for teaching critical thinking is helpful. However, explicating how teachers teach and students learn critical thinking in actual clinical situations illuminates the contextual aspects of practice that influence learning to think (12). Conventional strategies teachers use to assist students to learn critical thinking include individual and group activities, discussions and interactions between students and teachers, clinical simulations, and problem-solving encounters. Although such strategies are commonly thought to be effective in teaching critical thinking in classroom or laboratory situations, little research has been conducted to evaluate the relationship between specific teaching strategies and students' ability to think critically in specific situations (1). A further limitation of laboratory and classroom strategies is that they need to be supplemented with contextual experiences. Providing students with opportunities to practice critical thinking in actual clinical situations is difficult because the context of care is rapidly changing and schools of nursing continue to allocate limited resources to practice education. This two-year study, which was undertaken to reveal common contemporary approaches to teaching and learning critical thinking in clinical courses, analyzes the lived experiences of 45 students and teachers. Part I describes a typical student's experiences of learning "nurse thinking" in the context of clinical practice. Part II describes a typical teacher's experiences creating opportunities for students to learn and practice critical thinking in a community clinical course.