critical thinking nursing course

What is Critical Thinking in Nursing? (With Examples, Importance, & How to Improve)

Successful nursing requires learning several skills used to communicate with patients, families, and healthcare teams. One of the most essential skills nurses must develop is the ability to demonstrate critical thinking. If you are a nurse, perhaps you have asked if there is a way to know how to improve critical thinking in nursing? As you read this article, you will learn what critical thinking in nursing is and why it is important. You will also find 18 simple tips to improve critical thinking in nursing and sample scenarios about how to apply critical thinking in your nursing career.

What Is Critical Thinking In Nursing?

4 reasons why critical thinking is so important in nursing, 1. critical thinking skills will help you anticipate and understand changes in your patient’s condition., 2. with strong critical thinking skills, you can make decisions about patient care that is most favorable for the patient and intended outcomes., 3. strong critical thinking skills in nursing can contribute to innovative improvements and professional development., 4. critical thinking skills in nursing contribute to rational decision-making, which improves patient outcomes., what are the 8 important attributes of excellent critical thinking in nursing, 1. the ability to interpret information:, 2. independent thought:, 3. impartiality:, 4. intuition:, 5. problem solving:, 6. flexibility:, 7. perseverance:, 8. integrity:, examples of poor critical thinking vs excellent critical thinking in nursing, 1. scenario: patient/caregiver interactions, poor critical thinking:, excellent critical thinking:, 2. scenario: improving patient care quality, 3. scenario: interdisciplinary collaboration, 4. scenario: precepting nursing students and other nurses, how to improve critical thinking in nursing, 1. demonstrate open-mindedness., 2. practice self-awareness., 3. avoid judgment., 4. eliminate personal biases., 5. do not be afraid to ask questions., 6. find an experienced mentor., 7. join professional nursing organizations., 8. establish a routine of self-reflection., 9. utilize the chain of command., 10. determine the significance of data and decide if it is sufficient for decision-making., 11. volunteer for leadership positions or opportunities., 12. use previous facts and experiences to help develop stronger critical thinking skills in nursing., 13. establish priorities., 14. trust your knowledge and be confident in your abilities., 15. be curious about everything., 16. practice fair-mindedness., 17. learn the value of intellectual humility., 18. never stop learning., 4 consequences of poor critical thinking in nursing, 1. the most significant risk associated with poor critical thinking in nursing is inadequate patient care., 2. failure to recognize changes in patient status:, 3. lack of effective critical thinking in nursing can impact the cost of healthcare., 4. lack of critical thinking skills in nursing can cause a breakdown in communication within the interdisciplinary team., useful resources to improve critical thinking in nursing, youtube videos, my final thoughts, frequently asked questions answered by our expert, 1. will lack of critical thinking impact my nursing career, 2. usually, how long does it take for a nurse to improve their critical thinking skills, 3. do all types of nurses require excellent critical thinking skills, 4. how can i assess my critical thinking skills in nursing.

• Ask relevant questions • Justify opinions • Address and evaluate multiple points of view • Explain assumptions and reasons related to your choice of patient care options

5. Can I Be a Nurse If I Cannot Think Critically?

The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

The university of tulsa Online Blog

Trending topics in the tu online community

Why Critical Thinking Skills in Nursing Are Essential

Written by: university of tulsa   •  feb 29, 2024.

Why Critical Thinking Skills in Nursing Are Essential ¶

Working in health care requires quick thinking and confident decision-making to care for patients. While nurses use a broad range of technical skills to provide quality care, an essential skill that’s easy to overlook is critical thinking. Nursing professionals should explore the benefits of critical thinking skills in nursing, how to apply them, and the ways that advanced education can sharpen their ability to make precise decisions.

Critical Thinking Skills: A Definition ¶

Critical thinking is the process of evaluating facts, interpreting information, and analyzing situations to make informed decisions in various situations. Finding the correct answer to a complex problem isn’t easy. When situations don’t have clear answers and many factors to consider, critical thinking can help individuals move forward and make decisions.

Critical thinking competencies can be applied to a wide range of workplaces and personal situations. In nursing, critical thinking skills can help deliver effective care, handle a patient crisis, and assess the efficacy of treatment plans.

The Importance of Critical Thinking Skills in Nursing ¶

The fast-paced nursing environment requires prompt, data-driven decisions. Nurses use critical thinking daily, reviewing information and making decisions to promote quality care for patients. The following benefits of critical thinking highlight the importance of this skill in nursing careers:

Improves decision-making speed. A critical thinking mindset can help nurses make timely, effective decisions in difficult situations. A systematic method to evaluate decisions and move forward is a powerful tool for nurses.

Refines communication. Improving professional communication allows for factual, efficient, and empathetic conversations with patients and other health care professionals.

Promotes open-mindedness. It’s easy to overlook certain opinions or viewpoints in a high-pressure situation. Thankfully, critical thinking promotes open-mindedness in exploring solutions.

Combats bias. A critical look at different behaviors, contexts, and viewpoints can be helpful for identifying and addressing bias. Nurses must actively seek out ways to confront and remove bias in the workplace.

Critical Thinking in the Nursing Process ¶

There are many ways to apply critical thinking skills to nursing situations. The nursing process is a five-step process to assist nurses in applying critical thinking skills to their daily duties. Experienced nurses and professionals considering a career change to nursing should review the steps as part of their critical thinking process.

Step 1: Assessment ¶

Assessing a patient means far more than taking their vital signs. It also includes collecting sociocultural and psychological data. Lifestyle factors and experiences can affect the treatment process and approach, so skilled nurses review these areas before moving toward the next step, diagnosis.

For example, if a patient reports dizziness or shortness of breath, a nurse should not only check the patient’s temperature, blood pressure, and heart rate but also ask about their family history and recent events.

Step 2: Diagnosis ¶

During the second step, a nurse’s assessment and critical thinking skills produce a clinical judgment. Nurses need to carefully consider all the factors included in the first step. When necessary, consult with other health care professionals before reaching a diagnosis or communicating that diagnosis with the patient.

Discussing a patient’s assessment with other health care professionals requires critical thinking, as the information provided about vital signs, recent events, and family history are key components of this step.

Step 3: Planning ¶

A nurse may be responsible for setting goals and planning a treatment plan for patients. The third step can include setting measurable, achievable goals. Nurses also coordinate care with other health care professionals.

Goals can be simple or complex, depending on the assessment and diagnosis. For example, one patient’s goals may include eating three meals a day, while another’s may include having multiple medications, specialist visits, and physical therapy activities as part of their treatment plan.

Step 4: Implementation ¶

Critical thinking is needed to implement the nursing process, finding ways to carry out the plan with empathy. It’s also important for nurses to document care throughout the fourth step of the process.

For example, nurses should review patient history and consider symptoms before administering medication. Nursing professionals should also think critically about which patients to see first and how to prioritize patients who may need critical attention.

Step 5: Evaluation ¶

Nurses need to continue to evaluate and review the patient’s condition using critical thinking. Evaluation allows nursing professionals to review patient conditions, recommend care plan modification, and consider overall patient status.

For example, identifying whether patients may be ready for a care plan modification or another change in care requires critical thinking and a clear, focused evaluation of multiple patient factors.

How to Foster Critical Thinking Through Nursing Education ¶

Critical thinking is integral to success in the health care field. Thankfully, many ways are available for nurses to improve their critical thinking skills. Below are training, mentoring, and education options for fostering critical thinking.

On-the-Job Training ¶

Because critical thinking is so critical to the daily duties of nurses, experience in the field can improve their ability to evaluate situations and make data-driven decisions. Working firsthand with patients and alongside skilled professionals is a powerful way to see and apply critical thinking in real-world scenarios.

Mentoring Opportunities ¶

Nurses should seek mentorship opportunities for personalized, side-by-side instruction and inspiration from fellow professionals. Mentorships can be either formal or informal opportunities to learn from skilled nurses and health care professionals to promote critical thinking.

Further Education ¶

Many continuing education opportunities are available for nurses. Professionals looking to improve their critical thinking skills should consider enrolling in a course that promotes reflection, evaluation, and analytical thinking.

Review Critical Thinking Skills With The University of Tulsa ¶

Expand your critical thinking skills in nursing by enrolling in a program to earn a degree in the field. The University of Tulsa offers an accelerated online RN to Bachelor of Science in Nursing (RN to BSN) program for students to earn their BSN in as little as 12 months. Take 30 credits of online courses to expand your medical knowledge, general education, and critical thinking abilities. Review the features of this online opportunity to see if it’s the right decision for your career.

Recommended Readings:

The Benefits of Nurse Mentoring

Hospice Nurse: Job Description and Salary

Work-From-Home Safety Checklist: Securing Your Virtual Workspace

American Nurses Association, The Nursing Process

American Nurses Association, What Are the Qualities of a Good Nurse?

Forbes , “The Power of Critical Thinking: Enhancing Decision-Making and Problem-Solving”

Indeed, “Critical Thinking in Nursing (Definition and Vital Tips)”

Indeed, “Critical Thinking Skills in Nursing: Definition and Improvement Tips”

Indeed, “15 Essential Nursing Skills to Include on Your Resume”

StatPearls, “Nursing Process”

Recent Articles

6 Tips for New Nurses

University of Tulsa

Apr 17, 2024

Becoming a Nurse Executive: How MSN Graduates Can Climb the Ladder

Apr 12, 2024

Cybersecurity Internships and Resources

Learn more about the benefits of receiving your degree from the university of tulsa.

• Skip to main content
• Skip to footer

Incredible Health

Empowering healthcare professionals to find and do their best work.

Free CEU: Key Concepts of Critical Thinking in Nursing

Free Nursing CEUs / Nursing Critical Thinking

In this course, you will learn about critical thinking, and its importance in nursing. By the end of this course, you will be able to identify factors that impact the learning of critical thinking, and also strategies for teaching critical thinking. Included in this course are self-guided exercises to allow you to practice your critical thinking skills.

2 Contact Hours

Course Outline

• Introduction 
• What is Critical Thinking? 
• Why is Critical Thinking Important? 
• Critical Thinking Education 
• Strategies to Promote Critical Thinking 
• Critical Thinking Exercises 
• Conclusion  

How to earn your free nursing CEUs

Create a free account

Create an Incredible Health account and get access to an online library of premium continuing education courses for nurses.

Complete online courses fast

Courses are approved by the ANCC in all 50 states and designed to get you the education you need as quickly as possible.

Find your state’s nursing CEU requirements

Get instant certificates

Upon course completion certificates are available instantly. It’s that easy!

Nursing CEUs by State

Incredible Health CE courses are approved by the ANCC for nurses in all 50 U.S. states .

Connecticut

Massachusetts, mississippi, new hampshire, north carolina, north dakota, pennsylvania, rhode island, south carolina, south dakota.

• Washington, DC

West Virginia

Incredible health: trusted by nurses for careers, ceus, and more, testimonials from nurses like you.

“Over the past six years, I have spent thousands of dollars on continuing education units…Being able to access continuing education units anywhere and at any time for free through Incredible Health, will make the process much easier for nurses’ busy lifestyles.”

“My license is up for renewal and with your help I completed my 30 ceu needed for California. You are doing a great service for us nurses. There’s so much stress on us right now. You’ve made one less worry for me. Thank you.”

Elizabeth A.

“I signed up for the free CEU courses. They are 100% free, informative, and I can do them at my own pace. When you complete a course they give you a certificate to print out as well as email you the certificate to print later…I 100% recommend Incredible Health when you need to do your RN CEU!”

• Browse jobs
• Free nursing CEUs
• Interview questions
• Job search guides
• New nurse graduates
• Nurse advice Q&A
• Nurse specialty quiz
• Nurses blog
• Nursing degree guides
• Personal finance
• Resume guide

BROWSE JOBS

• Los Angeles
• Philadelphia
• San Francisco
• Schedule a demo
• Why Incredible Health
• Customer case studies
• Inside Incredible Health
• Contact & support

Critical thinking definition

Critical thinking, as described by Oxford Languages, is the objective analysis and evaluation of an issue in order to form a judgement.

Active and skillful approach, evaluation, assessment, synthesis, and/or evaluation of information obtained from, or made by, observation, knowledge, reflection, acumen or conversation, as a guide to belief and action, requires the critical thinking process, which is why it's often used in education and academics.

Some even may view it as a backbone of modern thought.

However, it's a skill, and skills must be trained and encouraged to be used at its full potential.

People turn up to various approaches in improving their critical thinking, like:

• Developing technical and problem-solving skills
• Engaging in more active listening
• Actively questioning their assumptions and beliefs
• Seeking out more diversity of thought
• Opening up their curiosity in an intellectual way etc.

Is critical thinking useful in writing?

Critical thinking can help in planning your paper and making it more concise, but it's not obvious at first. We carefully pinpointed some the questions you should ask yourself when boosting critical thinking in writing:

• What information should be included?
• Which information resources should the author look to?
• What degree of technical knowledge should the report assume its audience has?
• What is the most effective way to show information?
• How should the report be organized?
• How should it be designed?
• What tone and level of language difficulty should the document have?

Usage of critical thinking comes down not only to the outline of your paper, it also begs the question: How can we use critical thinking solving problems in our writing's topic?

Let's say, you have a Powerpoint on how critical thinking can reduce poverty in the United States. You'll primarily have to define critical thinking for the viewers, as well as use a lot of critical thinking questions and synonyms to get them to be familiar with your methods and start the thinking process behind it.

Are there any services that can help me use more critical thinking?

We understand that it's difficult to learn how to use critical thinking more effectively in just one article, but our service is here to help.

We are a team specializing in writing essays and other assignments for college students and all other types of customers who need a helping hand in its making. We cover a great range of topics, offer perfect quality work, always deliver on time and aim to leave our customers completely satisfied with what they ordered.

The ordering process is fully online, and it goes as follows:

• Select the topic and the deadline of your essay.
• Provide us with any details, requirements, statements that should be emphasized or particular parts of the essay writing process you struggle with.
• Leave the email address, where your completed order will be sent to.
• Select your prefered payment type, sit back and relax!

With lots of experience on the market, professionally degreed essay writers , online 24/7 customer support and incredibly low prices, you won't find a service offering a better deal than ours.

Popular Courses

• Annual Regulatory Requirements, Current Practice
• Controlled Substance Prescribing: The Tennessee Chronic Pain Guidelines
• Ohio Law Governing Drugs and Prescriptive Therapy
• HIV/AIDS: Current Evidence-Based Practice (Two Hour)
• Child Abuse: Pennsylvania Mandated Reporter Training, 3 hours - Initial Licensure
• Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19
• Domestic Violence, Sexual Violence, Intimate Partner Violence
• Long-term Care Nursing: Admission and Medicare Documentation
• Alzheimer's, Dementia, and Related Issues

Course Library

Critical Thinking

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

≥92% of participants will understand critical thinking and how to implement this skill into practice.

After completing this course, the healthcare professional will be able to:

• Explain the importance of critical thinking in healthcare.
• List examples of personal factors influencing our perception and practice of critical thinking.
• Identify the person ultimately responsible for proficiency in critical thinking.
• Summarize how increased experience can affect a healthcare professional's critical thinking skills.
• Identify two knowledge elements pertaining to critical thinking in healthcare.
• Identify three prerequisites for critical thinking.
• Describe ways in which empirical referents are measured.

• Complete Course
• 0 % complete

Introduction

Case study #1: greg, critical thinking vs. creative thinking, implementing critical thinking, the defining attributes of critical thinking, knowledge acquisition and knowledge application, analysis of information, case study #1 continued, informed decision making, antecedent for critical thinking, empirical referents, cognitive skills, critical analysis, the process, case study #2: anna, clinical discussion of anna, case study #3: mark, clinical discussion of mark.

• Take test and pass with a score of at least 80%
• Reflect on practice impact by completing self-reflection, self-assessment and course evaluation. (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)

The role of critical thinking in healthcare disciplines cannot be overemphasized. The ability to synthesize complex information and triage action based on critical analysis is a core skill to providing high-quality patient care. Papp et al. (2014) defined critical thinking as the ability to apply higher-order cognitive skills (such as conceptualization, analysis, and evaluation) and the disposition to be deliberate in that process, leading to an appropriate and logical action.

Greg K. is a 45-year-old male who presented with a constellation of symptoms, including fatigue, joint pain, skin rashes, and occasional fevers. Initially, the primary care physician suspected a viral infection, but when the symptoms persisted and worsened over several weeks, Greg was referred to a specialist for further evaluation.

Critical thinking is the cognitive search for one answer to a problem through logical thinking. It is a fundamental principle that underlies healthcare disciplines. Creative thinking begins with one problem but instead entertains multiple solutions. Healthcare professionals must be agile and innovative in recognizing and addressing clinical issues. A healthcare professional’s ability to practice critical thinking will significantly enhance or hinder their ability to make decisions in the healthcare setting. Critical thinking in healthcare is essential to professional accountability in providing quality patient care.

Repeated exposure to realistic and risk-free scenarios amplifies objective analysis skills, proficiency, critical thinking, and self-confidence (Al Gharibi et al., 2020) . Healthcare educational programs integrate simulation exercises into the curriculum to develop critical thinking using real-world scenarios (Guerrero et al., 2022) . Simple and complex scenarios are utilized to create situations where the students must make rapid decisions that directly impact patient outcomes. Self-reflection as part of the simulation exercise allows the student to understand better the ‘why’ behind the decision and consider alternatives that might improve outcomes in the future.

Cultural differences can affect how critical thinking is understood and applied. For example, in the United States, decision-making is considered an active component of critical thinking, whereas, in Thailand, there was a strong association between happiness and critical thinking.

Personal factors can also influence the way critical thinking is perceived and practiced. For example, decreased medical knowledge and lack of perceived time can negatively impact the ability to exercise critical thinking. Poor metacognitive skills, a fixed mindset, heuristics, and biases all affect the ability to think critically (Persky et al., 2019) .

Attributes of a concept are defining factors that must be present for critical thinking to be present and effective. According to The Foundation for Critical Thinking (2023) , attributes defining critical thinking include knowledge acquisition, knowledge application, information analysis, decision-making, and reflection.

The foundation of any healthcare education is knowledge, skills, and attitudes (Jiménez-Gómez et al., 2019) . Developing and expanding proficiency in critical thinking requires healthcare professionals to first exhibit competence in the expected knowledge base, including disease processes, treatment options, adverse medication reactions, and side effects. A fundamental knowledge base is acquired during initial program training, and continued growth in this knowledge base is expected as part of the ongoing healthcare profession. Critical thinking skills are enhanced as individuals accumulate new knowledge and apply it to intricate patient cases and complex healthcare scenarios. The foundational basis for critical thinking resides in acquiring and utilizing new information. Healthcare educational programs work “intensely to reduce dichotomies that are present in nursing programs, namely between theory-practice and training and reality” (Jiménez-Gómez et al., 2019) .  Each individual is responsible for developing their proficiency in critical thinking and growing in their profession to the point where “reflection, self-criticism, and professional responsibility are developed” (Jiménez-Gómez et al., 2019) .

Healthcare professionals are expected to analyze and prioritize clinical information when providing patient care. Examples include but are not limited to interpreting lab values, reviewing test results, accurately identifying patients whose clinical status is changing, and understanding the expected course of a medical process. The application and improvement of this skill with increasing professional experience positively contribute to the development of critical thinking skills and self-confidence (Al Gharibi et al., 2020; Guerrero et al., 2022; Jiménez-Gómez et al., 2019; Papp et al., 2014; Persky et al., 2019) .

The nurse practitioner meets with Greg K. and takes a detailed medical history, including past illnesses, travel history, and family medical history. Greg reports a family history of autoimmune disorders and a recent trip to a region known for tick-borne diseases. The nurse practitioner noticed that Greg’s symptoms were vague and could be associated with various conditions. However, the presence of joint pain and skin rashes raises suspicions of an autoimmune disorder.

Informed decision-making is a skill that must be taught to all students in healthcare professions before they enter the workforce. The practice and execution of informed decision-making can positively and negatively affect patient outcomes. Students within a healthcare profession can become inundated with clinical data daily, which can be irrelevant, relevant but not urgent, relevant and urgent, or critical. Healthcare professionals are expected to promptly analyze information and make quick decisions based on the available information. Note that a solid knowledge base and educational foundation will accurately impact the healthcare professional’s ability to practice informed decision-making (Al Gharibi et al., 2020; Foundation for Critical Thinking, 2023; Guerrero et al., 2022; Jiménez-Gómez et al., 2019; Papp, et a.l, 2014; Persky et al., 2019) .

Several hypotheses are considered, including lupus, rheumatoid arthritis, or tick-borne illness like Lyme disease. The nurse practitioner reviews laboratory results, including complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antinuclear antibody (ANA), and specific tests for Lyme disease. The results showed elevated ANA and positive Lyme disease antibodies. Based on the evidence, Lyme disease is suspected with possible autoimmune complications. The nurse knows from taking the medical history that there is a family history of autoimmune disorders. The nurse considers the evidence and knows that there is still uncertainty about whether the symptoms were solely due to Lyme disease or if an underlying autoimmune condition was contributing. The nurse practitioner consults with her colleagues in infectious disease and rheumatology to gain insights into the complex presentation. They collectively reviewed the evidence, including clinical findings and test results.

Reflection focuses on reviewing the thinking process to identify ways in which improvement can occur. The process of reflection resembles debriefing following an event or a critical clinical situation. The process can be performed as an individual or as a team. It allows for improvement in future scenarios since it allows team members to review each action to determine if it is appropriate and timely. It can also enable the team to examine the role of team members or adjust systems and processes that are applied in the critical thinking process. It permits the individual or group to identify gaps in knowledge that need to be remediated and allows for cognitive growth (Foundation for Critical Thinking, 2023; Guerrero et al., 2022; Jiménez-Gómez et al., 2019; Papp et al., 2014; Persky et al., 2019) .

Greg K. was started on antibiotics for Lyme disease, and a watchful waiting approach was taken for the autoimmune component. Follow-up appointments were scheduled to monitor Greg’s process and adapt the treatment plan as necessary.

Open-mindedness, autonomy, and knowledge are prerequisites for critical thinking that affect the student’s or professional’s capacity to engage in critical thinking. A vital requirement for critical thinking is the learner’s willingness to remain open-minded. Open-mindedness prepares the learner to consider alternative solutions or courses of action for improved outcomes. In the case study above, the nurse remained open-minded to the possibility that Greg’s symptoms may not all be attributed to Lyme disease. Being open-minded in this situation allowed the identification of an underlying factor beyond the immediate illness.

Autonomy has also been identified positively as a prerequisite for critical thinking. Independent thinking is paramount for clinicians who want to become critical thinkers. The process needs to become internalized and automated within the individual. In the case study presented, the nurse practitioner consulted with colleagues on the case, but ultimately, the decision on how to proceed with treatment remained with the nurse practitioner.

Critical thinking increases competence in clinical practice, which in turn improves patient outcomes. Clinical competence among graduates from healthcare educational programs is not homogenous and highly depends on the curriculum's focus on developing critical thinking skills. Employers are keen to recruit professionals with a solid educational foundation and have refined their critical thinking skills to a competent or expert level.

Knowledge is not enough to ensure a healthcare professional's competence. The ability to apply the acquired knowledge to positively affect the patient’s health outcomes is the fundamental skill that critical thinking exercises can assess for and improve. Remaining open-minded, retaining autonomy while exploring other options with colleagues, and having a solid knowledge base are all foundational to implementing critical thinking.

The final part of concept analysis in critical thinking is identifying empirical referents. An empirical referent in critical thinking within healthcare professions is the clinical competence of the professional. The professional is duty-bound to maintain clinical competence in their area of practice. One method of evaluating the empirical referent of clinical competence is to measure patient quality care outcomes.

Healthcare professionals must adjust to swiftly evolving clinical circumstances and utilize minimal resources to care for patients with complex medical conditions. These clinical practitioners must navigate medical situations that are often ambiguous, multifaceted, and stressful, where each decision can trigger a series of events that may ultimately determine the fate of the patients under their care.

In cases where traditional interventions are not effective, clinicians must use creative thinking combined with critical thinking to come up with patient-specific solutions that are quickly implemented and flexible so that they may be adaptable to other patients.

There are six basic cognitive skills required for critical thinking. These include interpretation of information, critical analysis, evaluation through establishing the validity and reliability of information sources, explanation, and self-regulation (Pesky et al., 2019) .

Critical analysis is applied to a clinical scenario to separate clinically relevant information from unnecessary information. To that end, the Socratic method can be used where the clinician asks questions and seeks answers to distinguish between factual information versus what one believes. It is used to examine data and consider the consequences of any actions. This method can apply anywhere within a task, such as history taking or when finalizing the treatment care plan. The technique can also be applied at the end of a shift or the end of a procedure (Shirazi & Heidari, 2019) .

Assessment of the reliability of the information a clinician processes is necessary for critical thinking. A clinician incapable of making significant decisions independently and quickly in critical situations becomes part of the problem instead of part of the solution. Analyzing essential data and distinguishing between problems that require urgent intervention and those that are not life-threatening is material to positive patient outcomes (Shirazi & Heidari, 2019) .

Independence of thought is necessary for maturity in critical thinking. The critical thinker must remain impartial in their decision-making process. Developing both inductive and deductive reasoning skills is crucial.

While providing routine care, clinical professionals typically make decisions using minimal critical thinking skills, primarily relying on habit. Critical thinking skills become essential when an unusual or abnormal event occurs , compelling clinicians to employ advanced critical thinking abilities.

In most healthcare professions, the process is an essential method of systemic and rational planning in providing specialized care in a patient-centric manner. The process has five parts: assessment, diagnosis, planning, implementation, and evaluation (ADPIE).

“Intuition is the perception and understanding of concepts without the use of conscious reasoning” (Papathanasiou et al., 2014) . It is typically not considered an appropriate technique for clinical decision-making. Some clinicians view it as a type of educated guessing, whereas others regard it as an integral component of clinical knowledge and skill acquisition. Some maintain that clinical instincts can be cultivated and refined through experience, rendering experienced clinicians invaluable. Note, however, that intuition is highly dependent upon clinical experience. The reliance on intuition should be discouraged with new graduates.

You are a nurse working in a post-surgical unit. Anna K is a 70-year-old Asian female who recently underwent abdominal surgery for a benign tumor. She was admitted to your unit within the last 24 hours. Her past medical history includes hypertension, type 2 diabetes, and depression. The surgery was uneventful, and Anna was stable during her post-operative recovery.

On the morning of postoperative day two, Anna’s vital signs were within normal range, but she had become restless and agitated by lunchtime. She rated her abdominal pain at a level 6 on a scale of 0 to 10 and described a “sharp stabbing” pain around the incision. Her dressing initially appeared dry and intact but has not been rechecked since the beginning of the shift. Her urine output is lower than expected, and she has not had a bowel movement since the surgery.

The nurse must have a fundamental knowledge base about surgical procedures to fully understand Anna's risks. Although her vital signs were initially stable, her status has changed with the increase in pain and clinical presentation. This situation requires the nurse to complete a new assessment, including vital signs. During the assessment, the nurse must use critical thinking skills, pulling from her knowledge about surgery and infection, to problem-solve the underlying issues that may be contributing to her increasing pain, restlessness, and agitation.

The nurse’s priority is to assess Anna’s pain further. It is critical to determine the nature, location, and intensity of the pain and inquire about any other associated symptoms that might be present, including nausea or vomiting, which could indicate paralytic ileus.

The surgical site should also be inspected again, along with auscultation of her bowel sounds to assess for borborygmus, signs of infection, hematoma, or dehiscence, which could cause increased pain and might require immediate intervention. Given Anna’s low urine output, the nurse should also consider dehydration as inadequate fluid intake could contribute to restlessness, abdominal discomfort, and constipation. Fluid replacement should be considered in collaboration with the medical provider to avoid fluid overload in patients with hypertension.

A medication review, including any analgesic or opioids administered for pain, should also be completed. If Anna did not receive any pain medication as scheduled, this could be contributing to her increasing pain at this time. Pain medication can also contribute to constipation.

If not already addressed, patient education regarding the importance of deep breathing exercises, coughing, and early ambulation to prevent post-surgical complications should also be considered and done. Helping Anna understand the expected course of recovery and what symptoms to report to staff allows her to have some control over her recovery process. It helps with early intervention if problems develop, especially after discharge.

As the nurse, you completed a full nursing assessment with vital signs and medication review. You found that the patient had a low-grade fever with redness and drainage around the incision site. A call was made to the surgeon, reporting the new findings. The surgeon came to the unit and completed a wound culture before ordering a new antibiotic with dressing changes every four hours. Anna’s pain was managed with her new treatment plan, and the crisis was averted with early intervention. Knowledge base is vital to critical thinking and is foundational for positive patient outcomes.

You are an outpatient Doctor of Physical Therapy who receives a referral for Mark, a 36-year-old man with a diagnosis of low back pain with sciatica. He has a history of episodic low back pain, for which physical therapy and NSAIDs have helped in the past. He is presently on Naproxen sodium 500mg, twice daily, as an anti-inflammatory and pain reliever, as well as Flexeril for muscle spasms at night. He was initially seen by his primary care physician, who performed an X-ray, which was unremarkable. Based on Mark's request and reports of past success with physical therapy, the primary care physician proceeds to refer him to physical therapy with a recommendation of joint mobilization, lumbar traction, and core stabilization exercises.

The patient is a well-developed, pleasant, healthy male of average weight and height. His gait is antalgic and guarded, and he demonstrates a severe unwillingness to move during his transitional movements from sitting to standing and while walking to the examination room and the plinth.  Upon patient interview, you are informed that he was lifting an iron support beam as part of his home construction project and immediately had severe pain in his lower back and down his right lower leg to his toes. He does not volunteer information about bowel or bladder control, but once asked; he does admit that he lost bladder control yesterday. He simply could not feel that he had to go. He attributed this to being distracted by his severe pain. He noted that “something weird” was happening when he used the restroom, and both legs went numb whenever he tried to urinate or have a bowel movement. He reports that he has not been sexually active since his injury. Upon examination, he demonstrates immediate pain reproduction with slight forward flexion and extension.  Special testing revealed a positive straight leg raise test at 15 degrees on the right lower extremity and 20 degrees on the left lower extremity. He has decreased bilateral reflexes in the L4, L5, and S1 reflexes and a non-dermatomal decreased sensation to light touch in his bilateral feet and lower legs right>left. He has bilateral weakness with manual muscle testing in his quadriceps, anterior tibialis, fibularis, and ankle plantar flexors. When tested in sitting, he had more than three beats of clonus in his plantar flexors on the right foot.

In Mark’s case, you must use your critical thinking skills to determine if Mark is appropriate for outpatient physical therapy. Once you have completed your evaluation, you need to decide if you will treat Mark, and if so, is Mark appropriate for manual therapy, traction, and exercises as recommended by his primary care physician, or does Mark require further diagnostic imaging or referral to a different specialist? Clinically, you need to decide if you will treat Mark, treat and then refer him to another specialist, or refer him without physical therapy treatment.

Given the severity of Mark's pain, a positive straight leg raise in the affected and contralateral lower extremity, weakness, and reflex alterations in multiple nerve roots, there is concern for a severe rupture of one of his lumbar discs. Often, severe discs can be treated with exercise and traction in combination with the medications that Mark has already been prescribed. It is essential that you, as the Doctor of Physical Therapy, recognize the more severe and concerning symptoms of bladder incontinence and Mark's report of his legs “going numb” when he tries to urinate or attempts a bowel movement. These symptoms are red flag symptoms and could be indicative of cauda equina syndrome, and while rare, are an actual emergency. Mark needs to be referred to the Emergency Department immediately for further testing. Mark’s wife took him immediately to the nearest emergency department, where they performed an MRI and determined Mark did have a massive disc herniation, creating cord and nerve root compression. It was recommended that he have immediate, emergent surgery for decompression.

In the case studies above, critical thinking was pivotal in the patient outcomes. The critical thinking process involved gathering comprehensive information, identifying patterns, generating hypotheses, evaluating evidence, consulting with colleagues , and refining the diagnosis and treatment plan. All healthcare professionals must prioritize critical thinking as an essential skill. Critical thinking commands respect and is highly sought-after in 21st-century professional practice. With healthcare systems growing in complexity, practitioners are tasked with seamlessly blending healthcare expertise with ever-evolving technological advancements. Proficiency in critical thinking is ultimately the responsibility of each clinician.

Select one of the following methods to complete this course.

Implicit bias statement.

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

• Al Gharibi, K., & Arulappan, J. (2020). Repeated Simulation Experience on Self-Confidence, Critical Thinking, and Competence of Nurses and Nursing Students- An Integrative Review.  SAGE open nursing, 6 , 2377960820927377. Visit Source .
• The Foundation of Critical Thinking. (n.d.). Defining Critical Thinking . Visit Source .
• Guerrero, J., Ali, S., & Attallah, D. (2022). The Acquired Critical Thinking Skills, Satisfaction, and Self Confidence of Nursing Students and Staff Nurses through High-fidelity Simulation Experience. Clinical Simulation in Nursing , 64, 24-30. Visit Source .
• Jiménez-Gómez, M. A., Cárdenas-Becerril, L., Velásquez-Oyola, M. B., Carrillo-Pineda, M., & Barón-Díaz, L. Y. (2019). Reflective and critical thinking in nursing curriculum.  Revista latino-americana de enfermagem, 27 , e3173. Visit Source .
• Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical Thinking: The Development of an Essential Skill for Nursing Students. Acta Informatica Medica, 22 (4), 283-286. Visit Source .
• Papp, K., Huang, G., Lauzon Clabo, L., Delva, D., Fischer, M., Lonopasek, L., Schwartzstein, R., & Gusic, M. (2014). Milestones of critical thinking: a developmental model for medicine and nursing. Academic Medicine: journal of the Association of American Medical Colleges , 89(5), 715-20. Visit Source .
• Persky, A. M., Medina, M. S., & Castleberry, A. N. (2019). Developing Critical Thinking Skills in Pharmacy Students.  American journal of pharmaceutical education, 83 (2), 7033. Visit Source .
• Shirazi, F., & Heidari, S. (2019). The Relationship Between Critical Thinking Skills and Learning Styles and Academic Achievement of Nursing Students. The Journal of Nursing Research , 27(4), e38. Visit Source .

Expired Courses

Child Abuse: Iowa Mandatory Reporter Training Acupuncture Adolescent Holistic Health Issues AED Actualizacion de las Leyes de la Florida Anthrax Asthma Biological and Chemical Terrorism CHF: Eliminating Failure Childhood Immunization Creutzfeldt-Jakob Disease (CJD) Cuidado Paliativo Cultural Diversity Training: Ethnogeriatrics Deep Vein Thrombosis and Pulmonary Embolism Allergic Reactions Amyotrophic Lateral Sclerosis Attention Deficit and Hyperactivity Disorder Bioterrorism and Weapons of Mass Destruction Care of the Surgical Patient Chemical Dependence: Substance Abuse Compartment Syndrome Critical Care Environment: Strategies for Success Cultural Diversity Training: Ethnogeriatrics Guillain-Barre' Syndrome Hip Arthroplasty Hyponatremia Introduction to Epidemiology Legal Nurse Consultant (LNC) Medical Malpractice Case Review Major Trauma Assessment Middle Eastern Respiratory Syndrome (MERS) Neonatal Jaundice NEONATAL THERMOREGULATION Osteoporosis Parasitic Worm Infestation Pediatric Competency Preventing Central Venous Catheter Infections Reimbursement Of Healthcare Severe Acute Respiratory Syndrome (SARS) Sleep Disorders Trauma Assessment Tuberculosis in Spanish Ventilators Von Willebrand Disease Domestic Violence (Kentucky) Elder Abuse for Iowa Healthcare Professionals HANDWASHING: CURRENT CDC RECOMMENDATIONS Hemodynamic Monitoring Hepatitis C in Spanish Hypertension In Pregnancy Laminectomy Leadership for Healthcare Professionals Magnet Status Mental Retardation; Special Healthcare Needs Neonatal Cardiac Assessment and congenital Heart Disease Osteonecrosis of the Hip: Treatment Palliative Care and End-of-Life Care Patient Controlled Analgesia (PCA) PICU Competency Preparing the Patient for Surgery Restless Leg Syndrome Restraints and Seclusion in the Psychiatric setting Triage and Treatment STD Characterized by Urethritis and Cervicitis Transfusion of Blood and Blood Products Urinary Tract Infections: The Unappreciated Giant VIOLENCIA DOMESTICA ( Domestic Violence Anesthesia Awareness: Awake and Aware Antepartum Fetal Assessment Body Piercing Budgeting Concepts Cardiomyopathy Caring for Chronically Ill Children Chest Tube Drainage Systems Complete Blood Count (CBC) Interpretation Conflict Management Depression Eating Disorders Enfermedad de Alzheimer Errores Medicos Fibromyalgia Syndrome (FMS) H1N1 Novel Swine Influenza A Pandemic Hepatitis C Patient Safety and Assessment: Safe Use of Assistive Devices LDR Legal Nurse Consultant Updates Neonatal Glucose Management (pediatrics Neonatal Pain Management Neuroleptic Malignant Syndrome: When Drug Therapy Can Kill NICU Competency Osteonecrosis of the Hip: Diagnosis Parkinson's Disease and Deep Brain Stimulation Pediatric Emergencies Surgical Patient Care Prevention Of Surgical Site Infection Sexually Transmitted Diseases (STD) Human Papillomavirus Infection (Genital Warts) STD Characterized by Genital Ulcers Surgical Site Infection Surveillance (infection co) Total Parenteral Nutrition (TPN) Triage Tuberculosis UTI Uncomplicated: Acute Simple Cystitis Weapons of Mass Destruction

CEUfast.com Website News and Updates | A Nurse CE Provider CEUfast gains accreditation through AOTA | CEUfast News CEUFast Launches NYReq.com Solely For New York Required Courses | News Lowest Cost Nurse Aide CE Subscription in the Industry - CEUFast New Mexico Nurse CEs Now Reported to CE Broker by CEUfast Mandatory Reporter Child Abuse Course for Iowa Professionals | CEUfast CEUfast Releases Two Pennsylvania Mandated Reporter Training Child Abuse Florida Respiratory Therapists Can Take All of their CEs Online Meet Oregon CE Requirement with Our 6 Hour Pain and Management Course Polypharmacy CE Now Available on CEUFast CEUfast Enhances Courses with 3d4medical Animations CEUFast launches new Coronavirus Course to help participants better prevent CEUfast Now Accepts PayPal Payments CEUfast Now Reports to CE Broker for Georgia Nurses West Virginia Nurse Reporting to CE Broker Now on CEUfast Elizabethkingia Anopheles & Elizabethkingia Meningoepticum Nursing CEU “Don’t Mess With Nurses” Blog Goes Viral After ‘The View’ Debacle Lyme Disease Cases On the Rise in the Northeast New Requirement for Florida Nurses CEUfast Accommodates Changes to West Virginia CE Renewal Requirements Importance of infection control shown on CEUfast info graphic CEUfast Now Accepts Google Pay and Apple Pay CEUfast now reports to CE Broker for Arkansas nurses CEUfast now reports to CE Broker for South Carolina nurses CEUfast Relaunches Site with New Features and Updated Design CEUfast sheds lights on the dangers of polypharmacy with new infographic. Introducing Quiz Guru a Fun Learning Platform New Florida-required human trafficking course in progress Suicide prevention training courses required in Washington | CEUfast

State Pages

Pennsylvania Child Abuse Course Alabama Nursing CEUs Arkansas Nursing CEs - Instant reporting to CE Broker California Nursing CEUs | CEUfast Delaware Nursing CEs Florida Nursing CEUs Florida Nursing CEUs - No Tests Required Georgia Nursing CEUs Hawaii Nursing CEUs Louisiana Nursing CEs Michigan Nursing - All Required CEUs | CEUfast Montana Nursing CEs Nebraska Nursing CEs New Jersey Nursing CEs New Mexico Nursing CEs North Dakota Nursing CEs Ohio Nursing CEUs | CEUfast Pennsylvania Nursing CEUs Rhode Island Nursing CEs South Carolina Nursing CEs Texas Nursing CEUs Utah Nursing CEs Washington D.C. Nursing CEs West Virginia Nursing CEs Wyoming Nursing CEs

Reset Password Register Utah LPN License Renewal Guide Georgia RN License Renewal Guide Celebrating Nursing Assistant Week 2019 Florida LPN IV Certification - CEUfast CNA CEUs - Nationally accredited and state approved Clear Your CEUfast cookies. Cookies Policy Free Nursing CEUs - CEUfast Getting Started with CEUfast Accreditation US State / Territory Requirements Technical Issues? Electronic Reporting Julia-Tortorice Arkansas Nurse Salary Guide California Nurse Salary Guide Delaware Nurse Salary Guide Florida Nurse Salary Guide Hawaii Nurse Salary Guide Illinois Nurse Salary Guide Louisiana Nurse Salary Guide Maine Nurse Salary Guide Massachusetts Nurse Salary Guide Michigan Nurse Salary Guide Missouri Nurse Salary Guide Montana Nurse Salary Guide New York Nurse Salary Guide North Carolina Nurse Salary Guide Puerto Rico Nurse Salary Guide Texas Nurse Salary Guide Washington Nurse Salary Guide Alaska Nurse Salary Guide Colorado Nurse Salary Guide Georgia Nurse Salary Guide Iowa Nurse Salary Guide Maryland Nurse Salary Guide Mississippi Nurse Salary Guide Nevada Nurse Salary Guide Ohio Nurse Salary Guide Virginia Nurse Salary Guide CEUfast Featured on Fox's World Wide Business with Kathy Ireland

We're sorry! All our support agents are unavailable to chat at the moment.

Need Immediate Assistance? Please visit our FAQ section which provides answers to many common inquiries.

Get in Touch Directly via Email If your query is urgent or you'd prefer to reach us directly, we invite you to submit a support ticket through our Contact Us page . Our dedicated support team will review your inquiry and get back to you as soon as possible.

Support Hours Our chat support is typically available Monday to Friday, 9:00 AM - 6:00 PM EST. For support outside of these hours, please use our email contact

Are you sure?

02.01 Critical Thinking

Watch More! Unlock the full videos with a FREE trial

Included In This Lesson

Study tools.

Access More! View the full outline and transcript with a FREE trial

If you have gone to one day of nursing school you understand that “critical thinking” is a buzzword.

Nursing schools love to talk about critical thinking.

The job of a nurse is essentially to take millions of data points and be able to arrive at a correct decision based on that data.

This is no easy task and there are few jobs which require this on the scale of nursing or with human lives in the balance.

What is Critical Thinking?

Critical thinking is defined as: Clear, rational thinking involving critique. Its details vary amongst those who define it. According to Barry K. Beyer (1995), critical thinking means making clear, reasoned judgments. During the process of critical thinking, ideas should be reasoned, well thought out, and judged. The National Council for Excellence in Critical Thinking defines critical thinking as the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.  Source .

So, while you are familiar with making decisions on a daily basis, most daily decisions do not require critical thinking (what color of shirt should I wear, what should I eat for dinner, etc).

It is a skill that can grow and develop with time and as you enter nursing school you are not expected to be an expert in the skill.

However, what you should understand is that critical thinking involves a level of decision making far beyond normal day to day decision making. With critical thinking you are analyzing, conceptualizing, and digging deep into the questions presented.

When it comes to nursing, often times you are presented with real life or death situations. You are presented with saving one patient or determining what the most important solution is to a highly complex problem.

Those nurses who develop advanced critical thinking skills find increased success in their careers.

Critical Thinking in Nursing

So let’s talk about critical thinking and how it applies to everything we are talking about here.

The NCSBN website states the following: Since the practice of nursing requires you to apply knowledge, skills and abilities, the majority of questions on the NCLEX are written at the cognitive level of apply or higher. And these questions, by nature, require critical thinking.

Answering these correctly will require you to do something with what you have learned, to manipulate previously learned material in new ways or find connections between many facts.

Again, since the majority of NCLEX questions fall into this category, this is exactly the type of questions you need to practice answering!

There it is again . . . the BUZZ word (critical thinking) . . . but once again no tips or information on what that means or how to develop it is given.

So let’s dive in and provide you with a simple framework and method for developing critical thinking.

How to Critically Think in Nursing

While there are many frameworks and methods for developing critical thinking, here we will provide you with a basic 4 step method.

At the risk of sounding oversimplified, this simple method will allow you to cut through the clutter, think critically, and arrive at correct decisions in even the most complex of scenarios.

Essentially there are 4 steps to critical thinking . . . in nursing and in life . . . and developing the ability to critically think will work wonders in your life.

• Suspend ALL Judgement
• Collect ALL Information
• Balance ALL Information
• Make a Complete and Holistic Decision

Before diving into the four individual steps let’s point out the use of the word “ALL” in each of the steps.

This is important because few individuals can make decisions with this inclusive word. It literally means ALL. To make a complete and holistic decision based upon critical thinking you have to have and weight ALL information. Otherwise you are just making a regular old decision.

•   Suspend All Judgement

You have to start by suspending all judgement. In other words, if you walk into a patients room and see them tachycardic an amature decision would be to run and grab the metoprolol to try to drop the heart rate.

An advanced clinician will WAIT until they have more information . . . not leaving the patient untreated . . . but not jumping freakishly into the WRONG treatment because they learned that tachycardia is bad . . .

Suspending judgement means that you don’t make a decision based upon the first sign. You also don’t walk into any situation of NCLEX question with a decision already made. You will treat all facts as equal until you can gather the needed information.

Not suspending judgment leaves you open to make biased decisions. This is detrimental in medicine and nursing. This will also result in poor success on nursing exams and the NCLEX.

As you read through nursing questions you must force yourself to refrain from jumping to conclusions until you have read the question in full. Do not allow yourself to assume what the question is asking or what the patient outcome is until you have read the question in full.

Obviously this sounds simple, but it is this step that, if missed, will through more nursing students and nurses off.

• Collect All Information 

Now you must collect ALL information. This is clutch! Don’t make a decision until you have collected every piece of data that you need to collect . . . on a tachycardic patient you can check BP, temp, run an EKG, check urine output.

Think of this as data mining. You are looking to have every piece of information you can find to put the puzzle pieces together.

When it comes to taking nursing tests you only have one place that you can collect the information . . . and that is from the test question itself. Do not go looking outside of the question of infer any details that are not provided within the question.

One thing we have noticed students doing almost more than anything else on test questions is reading into them. Don’t do this. Gather all the information you can . . . and when it comes to NCLEX questions, the only place you can gather information is from the question itself.

• Balance All Information

Now, balance all information. This means take all the data that you have and start weighing it to find out what is pertinent and what you can ignore. If the temp is 98.9 . . . it’s probably not the cause. If the BP is 74/56 are we looking at a volume issue?

In this step you are deciding what is important and what isn’t. While a pressure ulcer is important, if the patient is actively having a heart attack . . . it just doesn’t matter. At least, not until we take care of the MOST important issue.

NCLEX style questions will be FULL of extra information, things that you just really do not need to know to make a decision on the patient.

The NCSBN (who administers the NCLEX) in an effort to simulate real life nursing writes questions that include both important information and details that you just simply don’t need to know. It is your job to sift through the data and determine what you actually need to know.

Balancing means giving each data point a level of importance for your given patient. Some pieces of information will score much higher than others.

At this point you must all consider the implications of the possible options. Look at the available options and think to yourself, “if I choose this option, what happens next?”. As it relates to nursing, ask yourself these questions:

“Does this achieve a desired patient outcome?”

“If I do this and then go home, what happens to my patient?”

Forcing yourself to consider the implications allows you to look beyond the information presented and consider the RESULTS of your choices. Critical thinking thrives on looking beyond the presented data.

• Make a Holistic Decision

Finally, make your decision . . . with all the data in and after looking over it all very closely you can begin to make your decision.

Your goal is to make the decision that best serves the patient and addresses their most immediate concerns.

Critical Thinking in Nursing and on the NCLEX®

Lastly, I just want to talk briefly about how this applies to NCLEX questions . . .

Here is an actual practice NCLEX question from our Nursing Practice Questions Program (or NPQ, as we like to call it)!

A 56-year-old male patient has been admitted to the cardiac unit with exacerbation of heart failure symptoms. The nurse has given him a nursing diagnosis of decreased cardiac output related to heart failure, as evidenced by a poor ejection fraction, weakness, edema, and decreased urinary output. Which of the following nursing interventions are most appropriate in this situation?

42% of the students that have taken this question have selected this answer:

Administer IV fluid boluses to increase urinary output

The problem with that answer is that it fails to weigh the most important issue facing this patient.

Test takers see urine output as low . . . and want to correct that quickly with fluids.

However, this is a CHFer . . . you can’t (shouldn’t) bolu especially during an exacerbation . . . you could send the patient into pulmonary edema and drastically impact their respiratory status.

So the lesson here. . . . in school, on the NCLEX, and on the clinical floor . . . slow down, stay calm and start thinking at an analysis level.

And I promise you this helps in “REAL” life too . . . not just in nursing. You will begin to be a tad more skeptical and deliberate with your decisions.

Here are a couple resources that will help you in the process of developing critical thinking.

• CriticalThiking.org
• US News 5 Tools
• Thinking Fast and Slow
• NPQ – Nursing Practice Questions

The process for developing critical thinking is slow and arduous. However, don’t be hard on yourself. According to  CriticalThiking.org  the vast majority of colleges are not appropriately incorporating critical thinking into the college classroom. This means that while you might not being taught the skill as you should . . . most people aren’t. Using the strategies outlined above will put you light years ahead of most.

The nurse that is able to follow these four steps is a tremendous asset on a clinical floor.

View the FULL Outline

When you start a FREE trial you gain access to the full outline as well as:

• SIMCLEX (NCLEX Simulator)
• 6,500+ Practice NCLEX Questions
• 2,000+ HD Videos
• 300+ Nursing Cheatsheets

“Would suggest to all nursing students . . . Guaranteed to ease the stress!”

View the FULL Transcript

Test taking for nursing students.

The Test-Taking course is the best place to start when you’re trying to figure out how to navigate NCLEX®-Style questions. Nursing school presents a unique challenge when it comes to test-taking. You’re no longer just looking for the right answer - you’re now looking for the most right answer or multiple right answers. In this course, we break down how to understand what these questions are even asking you, and our best tips for how to answer them. We also provide some strategies for goal-setting, studying, and note-taking that are sure to set you up for success on your exams and on the NCLEX®.

0 – Test Taking Course Introduction

1 – goals and studying, 2 – what is the nclex.

• 19 Questions

3 – Test Taking Strategies

• 12 Questions
• 10 Questions
• 22 Questions

4 – Note Taking

Flipping the Switch: Using the Flipped Classroom to Increase Student Critical Thinking and Engagement

• Alexis Zehler Miami University Author
• Britt Cole Miami University Author

The literature supports the concept of a flipped classroom as a pedagogical approach that can improve critical thinking, enhance clinical judgment, and promote student engagement. This project implemented the flipped classroom concept in two nursing specialty courses, one didactic and one clinical. Data were gathered from both courses using a mixed method approach to evaluate impact. The data demonstrated significant improvement in students’ critical thinking and clinical judgment, increased engagement, and increased positive perceptions of learning when the flipped classroom approach was used in course design

• Requires Subscription PDF
• Application

Access Agreement Journal on Excellence in College Teaching

Before proceeding you must agree to the terms and conditions of usage as outlined below by clicking on the Accept button and/or by both parties’ signatures below. You will have to do this only once. After agreement, you will be redirected back to the main Journal page. A pdf copy of the terms is available for download.

This Access Agreement (the "Agreement") is effective upon processing of payment ("Effective Date") and is entered into by and between the Journal on Excellence in College Teaching (“JECT”) and the Customer (“Customer").

This Agreement constitutes the entire agreement and supersedes and voids all prior communications, understandings, and agreements relating to the Product(s), including any terms of use displayed to Authorized Users via the online site of the Product(s). Alterations to the Agreement and to any Addendum to the Agreement are only valid and binding if they are recorded in writing and signed by both parties

. I. Definitions

"Authorized Users" shall mean individuals who are authorized by the Customer (which shall include those individuals authorized by the Institutions hereunder) to access the Customer's information services whether on-site or off-site via secure authentication and who are affiliated with the Customer as a student (undergraduates and postgraduates), employee (whether on a permanent or temporary basis), or a contractor of the Customer. Individuals who are not a current student, employee, or a contractor of the Customer, but who are permitted to access the Customer's information services from computer terminals within the physical premises of the Customer ("Walk-In Users"), are also deemed to be Authorized Users, but only for the time they are within the physical premises of the Customer. Walk-In Users may not be given means to access the Product(s) when they are not within the physical premises of the Customer.

"Commercial Use" shall mean use for the purpose of monetary reward (whether by or for the Customer or an Authorized User) by means of the sale, resale, loan, transfer, hire, or other form of exploitation of the Product(s). For the avoidance of doubt, neither recovery of direct cost by the Customer from Authorized Users, nor use by the Customer or Authorized Users of the Product(s) in the course of research funded by a commercial organization, shall be deemed to constitute Commercial Use.

"Educational Purposes" shall mean for the purpose of education, teaching, distance learning, private study and/or research as described in Section II below.

"Institutions" shall mean the Customer's participating institutions, if applicable.

"License" shall mean the non-exclusive, non-transferable right to access and use the Product(s) pursuant to the specific terms and conditions set forth in this Agreement.

"Product(s)" shall mean the products, materials and/or information contained therein that are subject to this Agreement. Product(s) include the Journal on Excellence in College Teaching and the archive of the Learning Communities Journal.

"Reasonable Amount" shall be determined based on guidelines set forth by 17 U.S. Code § 107 (Limitations on exclusive rights, Fair use).

"Secure Authentication" shall mean access to the Product(s) by Internet Protocol ("IP") ranges or by another means of authentication agreed between the Publisher and Customer or Institutions (if applicable) from time to time.

II. Authorized Use of Product(s)

Customer, the Institutions (if applicable), and Authorized Users may use the Product(s) for Educational Purposes as follows:

Analysis . Authorized Users shall be permitted to extract or use information contained in the Product(s) for Educational Purposes, including, but not limited to, text and data mining, extraction and manipulation of information for the purposes of illustration, explanation, example, comment, criticism, teaching, research, or analysis.

Course Packs . Customer, the Institutions, and Authorized Users may use a Reasonable Amount of the Product(s) in the preparation of course packs or other educational materials.

Digital Copy . Customer, the Institutions, and Authorized Users may download and digitally copy a Reasonable Amount of the Product(s).

Display . Customer, the Institutions, and Authorized Users shall have the right to electronically display the Product(s) to the extent necessary to further the intent and purpose of this Agreement.

Electronic Reserve . Customer, the Institutions, and Authorized Users may use a Reasonable Amount of each of the Product(s) in connection with specific courses of instruction offered by Customer.

Interlibrary Loan . The Customer and the Institutions shall be permitted to use Reasonable Amounts of the Content to fulfill occasional requests from other, non-participating institutions, a practice commonly called Interlibrary Loan ("ILL"). Customer and the Institutions shall fulfill such requests in compliance with Section 108 of the United States Copyright Law (17 USC S108, "Limitations on exclusive rights: Reproduction by libraries and archives") and the Guidelines for the Proviso of Subsection 108(2g)(2) prepared by the National Commission on New Technological Uses of Copyrighted Works (CONTU).

The electronic form of the Product(s) may be used as a source for ILL. Customer and the Institutions shall include copyright notices on all ILL transmissions. Notwithstanding anything herein to the contrary, in no event shall any non-secure electronic transmission of files be permitted.

Print Copy . Customer, the Institutions, and Authorized Users may print a Reasonable Amount of the Product(s).

Recover Copying Costs . Customer and the Institutions may charge a reasonable fee to cover costs of copying or printing portions of Product(s) for Authorized Users.

Scholarly Sharing . Authorized Users may transmit to a third party colleague in hard copy or electronically, Reasonable Amounts of the Product(s) for personal use, professional use, or Educational Purposes but in no event for Commercial Use. In addition, Authorized Users have the right to use, with appropriate credit, figures, tables, and brief excerpts from the Product(s) in the Authorized User's own scientific, scholarly, and educational works.

Text Mining . Authorized Users may use the licensed material to perform and engage in text mining/data mining activities for legitimate academic research and other Educational Purposes. Those uses beyond educational use shall require permission from the Publisher.

III. Restrictions

Except as provided herein, the institution shall make reasonable efforts to inform its authorized users not to use, alter, decompile, modify, display, or distribute the Product(s) as follows:

Alter Identification . Remove, obscure, or modify copyright notices, text acknowledging, attributions, or other means of identification or disclaimers as they appear. Alter Product(s).

Alter, decompile, adapt, or modify the Product(s), except to the extent necessary to make it perceptible on a computer screen, or as otherwise permitted in this Agreement. Alteration of words or their order is strictly prohibited.

Commercial Use . No Commercial Use of the Product(s) shall be permitted unless the Customer or an Authorized User has been granted prior written consent by an authorized representative of the Product(s). Use of all or any part of the Product(s) for any Commercial Use or for any purpose other than Educational Purposes.

Distribution . Display or distribute any part of the Product(s) on any electronic network, including without limitation, the Internet, and any other distribution medium now in existence or hereinafter created, other than by a Secure Authentication; print and distribute any portion(s) of the Product(s)s to persons or entities other than the Customer or Authorized Users, except as provided in Section II.

JECT acknowledges that the Customer cannot police or control the actions of its students, faculty, and other Authorized Users with respect to their use of the Product(s). In the event of abuse, the institution shall make prompt and reasonable efforts to heal the breach and notify the publisher.

IV. Term and Termination

This agreement shall commence on the Effective Date and shall remain in effect unless and until terminated as permitted herein (the "Term"). There is no perpetual electronic access to content made available during the term of the agreement.

JECT may terminate this Agreement if Customer violates any of the terms and conditions set forth herein. In the event of any termination of access, JECT will promptly notify the Customer of the basis for termination.

The Customer may terminate this Agreement if sufficient funds are not provided or allotted in future government-approved budgets of the Customer (or reasonably available or expected to become available from other sources at the time the Customer’s payment obligation attaches) to permit the Subscriber, in the exercise of its reasonable administrative discretion, to continue this Agreement.

In the event of any unauthorized use of the Product(s) by an Authorized User, Customer shall cooperate with JECT in the investigation of any unauthorized use of the Product(s) of which it is made aware and shall use reasonable efforts to remedy such unauthorized use and prevent its recurrence. JECT may terminate such Authorized User's access to the Product(s) after first providing reasonable notice to the Customer (in no event less than two (2) weeks) and cooperating with the Customer to avoid recurrence of any unauthorized use. In the event of any termination of access, JECT will promptly notify the Customer

. V. Refunds

In the event that a subscription is canceled by the Customer prior to the subscription end date, the following will be used as guidelines for refunds.

Electronic subscriptions . The Customer shall be entitled to a full refund within 14 days of the start of the most recent subscription term. Refunds requested after 14 days but no later than 60 days from the start of the most recent subscription term will be allowed, minus a 30% processing fee. Refunds will not be granted if requested more than 60 days after the start of the most recent subscription term.

Journal on Excellence in College Teaching Center for Teaching Excellence Miami University 317 Laws Hall Oxford, Ohio 45056

All rights reserved | Miami University | The Journal on Excellence in College Teaching

Main navigation

• Tous les cours
• Tous les programmes

NUR1 434 Critical Care Nursing Practicum (4 unités)

Offered by: École des sciences infirmières Ingram ( Sciences infirmières )

Vue d'ensemble

Sciences infirmières : Advancing nursing practice through clinical and research activities. Hospital-based studies involve planning and providing direct patient care; one-to-one discussions with their clinical teacher/preceptor; peer discussions; and clinical rounds, with the goal of enhancing the breadth and depth of critical thinking and clinical decision-making.

Terms: This course is not scheduled for the 2024-2025 academic year.

Instructors: There are no professors associated with this course for the 2024-2025 academic year.

Prerequisite(s): NUR1 320 , NUR1 327 and NUR1 339

Restrictions: Not open to students who have taken NUR1 334 .

Only open to B.N. (Integrated) students

**Due to the length of the clinical course, add/drop is the eleventh lecture day and withdrawal is the fifteenth lecture day.

**In order to secure placement in clinical course, the add/drop is March 30, 2022 which is before the start of the course.

Department and University Information

Enrolment services.

• Dates Importantes
• Admission au premier cycle
• Admissions aux cycles supérieurs et postdoctoraux
• Horaire des cours
• Visual Schedule Builder
• Services aux étudiants

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.10(8); 2023 Aug
• PMC10333820

Curriculum framework to facilitate critical thinking skills of undergraduate nursing students: A cooperative inquiry approach

Christian makafui boso.

1 Department of Nursing and Midwifery, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town South Africa

2 School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast Ghana

Anita S. van der Merwe

Janet gross.

3 Peace Corps Liberia, Mother Patern College of Health Sciences, Stella Maris Polytechnic, Monrovia Liberia

Associated Data

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Critical thinking (CT) is vital in assisting nurses to function efficiently in the ever‐changing health care environment. A CT‐based curriculum framework provides the impetus necessary to drive the acquisition of CT skills of students. Yet, there is no known CT‐based framework contextualized to developing countries where seniority tradition is a norm. Therefore, the aim of this study was to develop a CT‐based curriculum framework to facilitate the development of CT skills of nursing students in developing countries.

Cooperative inquiry.

Using purposive sampling, 11 participants comprising students, educators and preceptors developed a CT‐based curriculum framework.

Findings were organized into a framework illustrating interconnected concepts required to foster CT skills of nursing students. These concepts include authentic student–facilitator partnership, a facilitator that makes a difference; a learner that is free to question and encouraged to reflect; a conducive and participatory learning environment; curriculum renewal processes and contextual realities.

1. INTRODUCTION

Nurses in today's volatile and complex health care environment need to be able to critically appraise information when giving care (Dozier et al.,  2021 ; Whiteman et al.,  2021 ). Nursing regulatory bodies worldwide such as the Nursing and Midwifery Council of Ghana ( 2015 ) and the South African Nursing Council ( 2014 ) recognize critical thinking (CT) as crucial for nurses. These bodies require that nursing curricula promote CT skills of students (Dozier et al.,  2021 ; Gholami et al.,  2016 ). The rationale is that individuals with CT skills are potentially able to make good clinical judgements (Dozier et al.,  2021 ; Gholami et al.,  2016 ) which may lead to good patient outcomes (Ward‐Smith,  2020 ).

Critical thinking‐based curricula adopt learning outcomes, instructional methods and assessment approaches that are grounded on the principles of CT. Such CT‐based curricula create a participatory and democratic learning environment for students. Students will be empowered if they are allowed to take risks, encouraged to make inputs, permitted to share their opinions and if their mistakes are rectified with dignity (Raymond et al.,  2017 ). Thus, as consistent with Billings & Halstead ( 2005 ) view, a curriculum should aim at enhancing active learning and the student–faculty interaction (as cited in Billings & Halstead,  2005 ). Learning environments where divergent views are suppressed (Raymond et al.,  2017 ), and the educator is seen as the authority of information (Boso & Gross,  2015 ) do not promote CT in students.

A considerable number of reforms in higher education have stressed the need to facilitate CT skills of students (Butler,  2012 ). CT courses have been introduced in different academic disciplines such as nursing, law, sociology, psychology and philosophy. Despite the attention CT has received, there remains doubt whether graduates are being prepared to think critically (Butler,  2012 ). At the heart of this challenge is the fact that the concept of CT has not been incorporated into the teaching methods of many educators (Billings & Halstead,  2005 ). For example, educators construct questions that are mostly at the lower level of thinking (Amoako‐Sakyi & Amonoo‐Kuofi,  2015 ). This suggests that educational institutions may be failing in their quest to develop CT skills of students (Dunne,  2015 ).

In many developing countries, nursing schools encounter challenges that may further compound the challenge of assisting students to engage in CT skills. For example, in Ghana, challenges such as limited resources in nursing schools (Talley,  2006 ) have been reported. Specifically, a lack of qualified educators (Bell et al.,  2013 ), infrastructural and logistical constraints (Talley,  2006 ), inappropriate instructional methods and large class sizes (Wilmot et al.,  2013 ) are some of the challenges affecting nursing education. Also, as indicated in the authors' previous articles (Boso et al.,  2020 , 2021c ), sociocultural norms uphold the seniority tradition. Traditionally, seniority is valued in most global societies. The aged are viewed as the source of knowledge, power and authority, thus seniority is a dominant cultural norm (Chen & Chung,  2002 ). For example, an individual is not expected to disagree or question an authority figure in public even if the authority figure appears to be wrong (Donkor & Andrews,  2011 ). The seniority tradition has been noted as a challenge to facilitating the CT skills of students (Chan,  2013 ; Raymond et al.,  2017 ). Meanwhile, the complexity of fostering CT skills of students has often been underestimated leading to diverse conceptualizations of CT (Dwyer et al.,  2014 ). Diverse conceptualizations could impede the development of CT skills of students.

Notwithstanding these challenges, a CT‐based curriculum framework could provide the needed impetus to foster the development of CT skills of students. A curriculum framework could provide ‘a means of conceptualizing and organizing the knowledge, skills, values, and beliefs critical to the delivery of a coherent curriculum that facilitates the achievement of the desired curriculum outcomes’ (Billings & Halstead,  2005 , p. 167). More importantly, a CT‐based framework provides a participatory and effective learning environment for both the learner and the educator (Dozier et al.,  2021 ; Duron et al.,  2006 ) even in societies where the seniority tradition is strongly adhered to. Yet, these authors could not identify a known curriculum framework to drive the facilitation of CT skills in the context of developing countries where the seniority tradition is a norm.

2. AIM OF THE STUDY

The aim of this study was to develop a CT‐based curriculum framework to facilitate the development of CT skills of nursing students in developing countries.

3. BACKGROUND

This study was underpinned by an eclectic model derived from Dwyer et al.'s ( 2014 ) and Duron et al.'s ( 2006 ) frameworks of CT development (see Figure  1 ). This eclectic model addressed four interconnected concepts relating to the exploration of experiences of students and educators towards CT skills facilitation namely CT, memory, comprehension (Dwyer et al.,  2014 ) and instructional activities (Duron et al.,  2006 ). These concepts are further explicated.

Eclectic model of critical thinking development adopted from Duron et al.'s ( 2006 ) and Dwyer et al.'s ( 2014 ) models of CT. Permission to adapt was obtained.

3.1. Critical thinking

There is no agreement about the definition of CT (Raymond et al.,  2018 ) and its relationship with memory and comprehension (Dwyer et al.,  2014 ). According to Davies and Barnett ( 2015 ), there are three main approaches to CT, namely, ‘skills‐and‐judgement’, ‘skills‐plus‐propensity’ and ‘skills‐plus‐disposition‐actions’ perspectives. The skills‐and‐judgement perspective of CT views CT as the possession of a set of characteristic skills. The skills‐plus‐propensity perspective highlights both skills and dispositions aspects of CT. While the ‘skills‐plus‐disposition‐actions’ view, also known as criticality, sees CT beyond skills and disposition to include actions/activism. The skills‐plus‐propensity view on which this study is based recognizes that activism is an outcome of CT and not necessarily an aspect of CT. Thus, Facione's ( 1990 ) definition accepted for the purposes of this study illustrates skills‐plus‐propensity perspective of CT: ‘…purposeful, self‐regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based…’ (Facione,  1990 , p. 5).

Though Facione's definition has been criticized for being long‐winded and difficult to implement (Davies & Barnett,  2015 ), its use for CT assessment in nursing education is evident (Raymond et al.,  2017 ). Dwyer et al.'s ( 2014 ) model incorporate both reflective judgement (skills) and self‐regulatory functions of metacognition (disposition) as requirements for CT consistent with Facione's ( 1990 ) definition. Self‐regulation refers to the individual's ability, willingness and perceived need to think critically when solving problems.

3.2. Memory

Critical thinking skills are dependent on what information one can remember (Dwyer et al.,  2014 ). Information is either stored in short‐ or long‐term memory. Dwyer et al. ( 2014 ) assert that through deliberate attention or perception processes, information is stored as short‐term memory (working memory). This short‐term memory includes two sub‐systems—phonological loop and visuospatial sketchpad; a central executive (attention focussing process that relates to long‐term memory) and episodic buffer (storage centre that integrates new information from working memory with existing memory from long‐term memory) (Baddeley,  2010 ). Through manipulation, information in short‐term memory may be encoded as long‐term memory. Long‐term memory is stored as schemas (categorization of knowledge based on how it will be used).

3.3. Comprehension

Meaningfully organizing information into schemas for future retrieval requires understanding or comprehension (Dwyer et al.,  2014 ). Comprehension encompasses the ability to translate or interpret information based on previous learning (Huitt,  2011 ). Long‐term memory and comprehension are fundamental processes for CT application (Dwyer et al.,  2014 ).

3.4. Instructional activities

Duron et al. ( 2006 ) designed a 5‐step model to provide a practical impetus in the acquisition of CT skills. This model focuses on steps that educators should take to foster the CT skills of students. The 5‐step framework requires that educators first determine learning objectives. The educator should identify the behaviours that the students should exhibit by the time they exit a course. The objectives should correspond to the higher order of Bloom's taxonomy. Secondly, the importance of teaching through questioning is underlined. The educator should design appropriate questions and questioning techniques to encourage discussion. The questions should vary and be concise to generate student participation. Particularly, divergent questions encourage CT. Thirdly, practice before assessing is considered important – inclusive of learning experiences that encourage active and experiential learning. Fourthly, the educator should continuously review, refine and improve instructional activities for CT skills. These include strategies such as evaluating students' participation through teaching, diary and journaling. Lastly, educators need to provide feedback and assessment of learning. Thoughtful, purposeful and timely feedback should be provided to students on their performance.

It is the contention of these authors that a CT‐based curriculum framework should address factors that either impede or enhance the students' abilities to memorize information (attention/perception processing), comprehend, reflectively make judgement (ability to analyse, evaluate and create) and engage in self‐regulation functions (disposition towards CT). Pursuant to this view, these authors observed classroom instructional practices (Boso et al.,  2020 ), explored the experiences of students and educators (Boso et al.,  2021c ) and assessed the CT disposition of students (Boso et al.,  2021b ). These studies revealed a number of issues that informed the development of a CT‐based curriculum framework. For example, challenges such as seniority tradition, large class size; negative attitude, lack of commitment and inappropriate assessment styles/methods of educators; background and culture, learning practices, lack of comprehension of the participant, distractive behaviour of students (Boso et al.,  2020 , 2021c ) were identified. Though students had a confident disposition towards reasoning, they did not have a mindset of truth‐seeking (Boso et al.,  2021b ). Lack of involvement of students in curriculum reviews and continuous professional development programs on CT for faculty were also identified as challenges in developing CT skills of students (Boso et al.,  2021c ). Also, educators' examination questions about a higher order of thinking constituted <6% (Boso et al.,  2021a ).

4.1. Research design

This article is the concluding part of a larger project (see Boso et al.,  2020 , 2021a , 2021b , 2021c ) that sought to develop a CT‐based curriculum framework. The study used participatory action research (PAR), specifically, cooperative inquiry (CI) as an overarching research design to develop a CT‐based curriculum framework. CI is one of the approaches embedded in PAR (Mash,  2014 ; Mash & Meulenberg‐Buskens,  2001 ) and is used interchangeable with PAR in this article. PAR inter alia assists in problem solving (Hart & Bond, 1995 ; Mash,  2014 ), promotes organizational improvement (Hart & Bond, 1995), bridges the theory–practice gap (Mash,  2014 ; Rolfe, 1996 ) and allows users to be involved (Beresford, 2006 ).

4.2. Study setting, population and sampling

The study was conducted in the nursing school of an accredited publicly funded university in Ghana. There were approximately 527 nursing students and 16 full‐time faculty members. Like many educational institutions in developing countries, the school had challenges such as a lack of sufficient qualified faculty, and infrastructural and logistical constraints that may militate against assisting students to acquire CT skills. For example, class sizes could range from 50 to 150 students.

The study participants included students who had been enrolled in the degree nursing program for at least a year, nurse educators with current full‐time appointments with at least a year of teaching experience, preceptors and coordinators of CT‐based medical programs. It is believed that these participants had been associated with the nursing educational system long enough to provide rich data on their experiences and expertise. Furthermore, using diverse stakeholders in the study aided in providing balanced perspectives.

Twelve participants comprised 3 educators (with 1 being a coordinator of a CT‐based medical program), 2 preceptors, 6 students and the researcher himself were part of the cooperative inquiry group (CIG). Pertinent to the tenets of cooperative inquiry, these CIG were to collaboratively engage to develop a CT‐based curriculum framework. To select students for the CIG, presentations on the purpose and nature of the study were made in their respective classrooms. A list of those who agreed to participate in the study was compiled based on the different educational levels. Individuals were randomly selected and contacted through email or telephone. Similarly, a list of preceptors was obtained. In the Ghanaian context, preceptors are clinical nurses who instruct students during clinical placement. They were contacted and those who were willing to participate were ranked based on their educational level and experience. Two preceptors with Master's degrees in nursing were selected to participate in the study as their clinical experience and educational background provided the necessary expertise towards developing the CT‐based curriculum framework. Two educators were randomly selected while the coordinator of the CT‐based medical program (also an educator) was purposively invited through email and/or telephone. The CIG was engaged throughout the entire research process to identify ideas, observe, and reflect on results to develop a framework to foster CT skills of students. Seven steps of the research process evolved till the aim of the study was met. Different data sets—qualitative and quantitative—were gathered and analysed, culminating in the development of the framework.

4.3. Summary of research process

In this study, O'Leary's cycle of action research as described by Koshy et al. ( 2011 ) was adopted. The process alternates from observation, reflection and planning to action. Seven steps from observation to action were followed during the entire research project (see Figure  2 ). The cooperative inquiry group members were engaged throughout the seven steps of the research process. In total, three workshop meetings were held.

Summary of research process.

4.3.1. Step 1

Data were collected on the instructional practices/activities of the selected school from September 2017 to March 2018. These data sets were to aid the CIG in understanding current practices and to provide the baseline data for the development of the framework. Factors that either inhibited or enhanced perception/attention processing and comprehension of information and reflective judgement (analysing, evaluating and creating) according to Dwyer et al.'s ( 2014 ) were identified. Prior to data collection, the participants were exposed to the research methodology and methods at a training workshop held in September 2017. Nine participants—the first author (initiating researcher), two preceptors, one educator and five students—were able to attend this session. The first author introduced the CIG members to the Nominal Group Technique (NGT). The NGT is considered one of the most frequently used formal consensus building techniques (Harvey & Holmes, 2012 ). The NGT includes five stages, namely: (1) introduction and explanation, (2) silent generation of ideas, (3) sharing ideas—round robin, (4) group discussion/clarifying and (5) voting and ranking. Measures to ensure the rigour of inquiry were discussed and agreed upon. Two educators who were unable to attend the session were met individually and the purpose and methods of the study were discussed with them.

4.3.2. Step 2

The analysed data from step 1 were presented to the CIG members at a second meeting held in March 2018. Nine participants—three educators, two preceptors, three students and the first author—were present at this meeting. The CIG deliberated on the results obtained through group discussions facilitated by the first author. Upon reflection, CIG agreed that the data provided enough basis for a draft framework to be considered. Vital issues about instructional practices had been elicited.

4.3.3. Step 3

Following the reflection on the data, the CIG through the Nominal Group Technique (NGT) facilitated by the first author designed a draft framework. Three questions were formulated for the NGT session, namely, (a) What concept(s) should be included in the framework that will facilitate CT skills of nursing students? (b) How should these elements/components/concepts/variables be related? and (c) What should the structure of the framework be?

At the first stage of introduction and explanation of the NGT, purpose of the study, NGT procedure and the three questions for the NGT procedure were reiterated to provide all members with the same point of reference. At the second stage of the NGT, members were allocated 5 minutes to generate ideas for the framework. Seventy‐six concepts were generated. These concepts were collated at the third stage of the NGT process. The fourth stage saw the concepts discussed, their meanings sought and consolidated. Through consensus, some concepts or synonyms were removed, leaving a total of 45 concepts. For example, the concept learner replaced and/or represented similar concepts such as student and nursing students. Likewise, facilitators replaced educators and/or lecturers. The 45 concepts were further consolidated (categorized) into nine. These included learner (and associated characteristics), educator/facilitator (and associated characteristics), teaching methods/style, learning environment, institutional support, assessment, technology, review system and curriculum. At the final stage, the CIG members voted to rank the concepts in order of importance. Learner, facilitator, teaching methods, learning environment and assessment were the five most ranked concepts. The first author was tasked to develop the draft framework with the concepts and relationships for the CIG members to review individually and for subsequent evaluation by students and educators for its applicability. Accordingly, the draft framework was designed by the first author together with one of the CIG members and subsequently distributed to all CIG members for input.

The draft framework suggested that the teaching‐learning process needed to be a caring professional relationship between the learner and the facilitator. This relationship should be the heart of the curriculum. The draft framework included six concepts/components which included: (a) caring professional relationship; (b) facilitator; (c) learner; (d) learning environment; (e) outcome setting, system review and advocacy and (f) contextual dynamics.

4.3.4. Step 4

The draft framework was made available to six educators and eight students in the selected school to review/comment on its applicability. The following questions accompanied the draft framework: How applicable is this framework in facilitating CT skills of students? What do you believe are the strength(s)/weakness(es) of this framework? What concept(s) do you believe should be removed and/or added to the framework to make it more applicable? Three educators and six students evaluated the draft framework. Given that these groups of participants are part of the nursing school, their views about the applicability of the framework were important to consider when implementing the framework in a real‐life situation.

4.3.5. Step 5

The students' and educators' comments and critiques about the draft framework were carefully analysed thematically by the first author. The draft framework was evaluated as applicable by all participants (3 applicable, 6 very applicable). The reasons for their choices included that the framework was simple, realistic, comprehensive (essential factors included), improved relationships for easier communication, made the facilitator a role model, made the learner an active participant and the learner's view was encouraged. Considering the strengths of the framework, the evaluators thought the framework was well structured, bridged gaps in the learner–facilitator relationship, comprehensively covered most factors of education, and covered current trends, and legal/regulatory issues.

The following were seen as the weaknesses of the draft framework by the evaluators: (a) difficulty to elicit commitment from all; (b) challenges associated with the hard environment; (c) possibility of being misused by students; (d) possible failure of the authentic student–facilitator partnership; (e) perceived difficulty to explain complex concepts/processes such as outcome setting, advocacy, system review and (f) possible lack of CT skills of learners and facilitators. They also thought concepts like culture, time, students' involvement, external motivation and career counselling should be included in the framework.

4.3.6. Step 6

The results of the evaluation of the draft framework were presented to the CIG at a workshop facilitated by the first author in May 2018. The comments and critiques of the framework were reflected on by the CIG for possible revision. Eight participants—two preceptors, five students and the first author were present at this 5‐h workshop. The CIG members considered the weaknesses identified during the evaluation as rather systemic challenges in the selected school and not of the framework. In their view, a framework should represent the ideal. Also, the CIG members thought culture, time and students' involvement were already captured.

4.3.7. Step 7

A revised framework was designed to reflect the views of the evaluators of the draft framework. Some concepts/processes were fine‐tuned, and others were further explicated by the members (see Results section for more details). For example, the caring professional relationship was altered to authentic student–facilitator partnership. Likewise, more extended phrases were used to provide further explication to the facilitator, learner and learning environment. Through NGT, ownership was suggested and added to the definition of authentic student–facilitator partnership. The CIG held the assertion that ownership will enhance responsible learner and educator behaviour. The final framework is presented in the Results section.

The results from the cooperative inquiry were organized into a framework illustrating interconnected concepts required to foster CT skills of nursing students in developing countries. The framework proposes six key interconnected thematic priorities (see Figure  3 ) to drive the development of CT of students. The concepts/themes included in the final framework were (a) authentic student–facilitator partnership, (b) a facilitator that makes a difference, (c) a learner that is free to question and encouraged to reflect, (d) a conducive and participatory learning environment, (e) curriculum renewal processes and (f) contextual realities. These six concepts are important components that should drive a curriculum based on CT principles. The concepts which emanated from the CIG discussions are described below.

Critical thinking‐based curriculum for undergraduate nursing program.

5.1. Authentic student–facilitator partnership

The authors of this study suggest that the central focus of the teaching–learning process should be authentic partnership between the learner and the facilitator (Raymond et al.,  2018 ). This view is motivated by the evidence of dysfunctional learner–facilitator relationships coupled with heightened students' perceptions of mistrust, lack of support, lack of emotional connectedness and lack of democratic practices informed by cultural realities identified (Boso et al.,  2020 , 2021c ). These authors define authentic student–facilitator partnership as a supportive, empathetic, learner‐directed, mutually respectful, accountable and democratic learning relationship which focuses on assisting a learner to engage in meaningful learning experiences toward the development of CT skills.

It is suggested that the educator takes responsibility for the optimum functioning of this partnership (Billings & Halstead,  2005 ; Mangena & Chabeli,  2005 ; Raymond et al.,  2017 ). However, both the student and the facilitator (Raymond et al.,  2018 ) should feel a sense of ownership of the teaching and learning process. The findings of this study suggest that factors relating to both students and facilitators could either facilitate or inhibit the fostering of CT skills acquisition. Consequently, both the student and the facilitator should be committed to setting up appropriate boundaries to govern this partnership. These boundaries should include adherence to educational justice—creating equal opportunities, fair evaluation, fair criticism and non‐discrimination on the basis of gender, race or religious status (Boozaripour et al.,  2018 ). Adherence to boundaries is likely to enhance the perception of trust and ownership.

5.2. A facilitator that makes a difference

We see the facilitator as the leader, role model, mentor and guardian of the student for a purposeful learning experience towards CT skills acquisition. It was evident in this study that the facilitator's approach to classroom management and general attitude towards students and cultural realities influenced how students engaged in the teaching and learning process (Boso et al.,  2020 , 2021c ). Cultural competence in healthcare is a global standard; thus, the facilitator should be aware of the influence of cultural tendencies (Chan,  2013 ; Donkor & Andrews,  2011 ) on the student–facilitator partnership. The facilitator should become a role model in terms of how he/she collaborates and communicates (Raymond et al.,  2018 ) as well as his/her punctuality to class. These general effective teaching tenets are required to set the tone for the reflective engagement of students towards the acquisition of CT skills. For example, a lack of punctuality will limit the amount of instructional time required for students to think critically. Also, the facilitator should demonstrate CT tenets in his/her teaching.

Furthermore, the facilitator needs to demonstrate scholarly attributes and experience in teaching, clinical skills, and theoretical nursing knowledge; be student‐centred, empathetic, supportive; and enthusiastic about the nursing profession and teaching (Billings & Halstead,  2005 ; Mangena & Chabeli,  2005 ; Raymond et al.,  2018 ). The facilitator needs to connect with the learner on an emotional level (Raymond et al.,  2018 ). It is proposed that the facilitator should use tools such as CT‐oriented learning outcomes/objectives, appropriate assessment for CT and active learning teaching approaches/methods. In addition, teaching and assessment methods should vary and should be driven by appropriate questioning techniques (Duron et al.,  2006 ; Raymond et al.,  2018 ). These questioning techniques should predominantly target higher‐order of thinking to help students to engage in appropriate thinking moments (Duron et al.,  2006 ).

5.3. A learner that is free to question and encouraged to reflect

The learner is the inquirer/discoverer of knowledge guided by the facilitator in an educational program. It was noted in this study that students were influenced by the Ghanaian cultural realities (Boso et al.,  2020 , 2021c ) that did not allow them to question authority (Donkor & Andrews,  2011 ) and the type of assessment/teaching methods to which they are exposed. These authors posit that to assist in fostering CT skills of learners, the students should not see themselves as a receptacle in which content/information is dumped, but rather as rational individuals who can decide for themselves regarding truth. Therefore, students should adopt CT‐oriented learning practices that ensure a reflective view of content/information for self‐determination and lifelong learning. This encourages facilitators to share their CT with students (Raymond et al.,  2018 ). In addition, they should be encouraged to be self‐motivated and self‐directed.

Strategies needed to promote CT skills in students should include the use of CT‐oriented learning outcomes/objectives, appropriate assessment for CT and active learning teaching methods. Additionally, teaching and assessment methods should vary and should be driven by appropriate questioning techniques (Duron et al.,  2006 ; Raymond et al.,  2018 ) which should target higher order of thinking to help students to engage in appropriate thinking moments (Duron et al.,  2006 ).

5.4. Conducive and participatory learning environment

The authentic student–facilitator partnership between the learner and the facilitator occurs in a conducive learning environment that promotes CT (Mangena & Chabeli,  2005 ; Raymond et al.,  2018 ). This environment has two components: hard and soft. The hard environment involves a library, learning space and technology. Appropriate use of technology should be employed in the teaching–learning process. This study showed that students were engaged in distractive use of social media and technology in the classroom (Boso et al.,  2020 ). Guidelines for the use of technology/social media should be available to help learners and facilitators derive maximum benefits from these tools. Also, institutional support is required for the provision of appropriate technology, learning space, appropriate class size and library resources for a meaningful learning experience (Raymond et al.,  2017 , 2018 ).

The soft environment involves the intangible safe, empathetic and democratic atmosphere created to encourage the learner to share his/her views freely. This conducive atmosphere should permeate the entire school environment. This helps to establish emotional connectedness between the students and other role players in the educational environment (Raymond & Profetto‐McGrath, 2005 ; Raymond et al.,  2017 , 2018 ). It was noted in this study that students did not feel adequately supported, and were not regularly engaged in curriculum reviews and other matters that directly affect their learning (Boso et al.,  2021c ). Consequently, we propose the establishment of a system of support (including financial aid) for students and practical avenues for students' engagements based on a consultative process involving students and other role players. Additionally, school managers should provide support to facilitators through staff development programs on CT. Assisting faculty development in the area of CT instructional methods will help educators to infuse CT tenets in their own courses (Mangena & Chabeli,  2005 ; Raymond et al.,  2017 , 2018 ). Measures such as assigning facilitators with teaching assistants should be adopted to give facilitators more time to engage in CT instructional practices (Shell,  2001 ). Facilitators in this study expressed the concern of inadequate time to engage students, partially due to the absence of teaching assistants.

5.5. Curriculum renewal processes

We propose that renewal processes should be adopted for a CT‐oriented curriculum as a whole and of parts as deemed necessary and considering local, national and international trends. The aim of these processes should be to encourage continuous feedback and review that will lead to curriculum improvement (Duron et al.,  2006 ). Students and other role players should be engaged in the curriculum renewal processes. In reviewing the curriculum, contemporary CT assessment theory and practices should be used. Furthermore, the renewal process should adhere to the standards of curriculum review processes. Also, the relevance of courses should be continuously examined to ensure that they attract students' engagement towards CT skills. Consistent with CT activism tenets (Davies & Barnett,  2015 ), advocacy should be encouraged to effect changes that may be occasioned by observations from the curriculum review. Particularly, educators should be encouraged to engage in advocacy to effect changes that may be necessary to assist students to acquire CT skills.

5.6. Contextual realities

A curriculum does not exist in a vacuum. It should be designed and operated in a specific context (Billings & Halstead,  2005 ). The learning process and the extent to which one can address CT skills are influenced by contextual realities. These contextual realities include the program of study, the global/national trends and policies and legal/regulatory framework. For example, as an undergraduate nursing program, CT is highly recommended as a competency (World Health Organization,  2009 ). It is therefore suggested that CT should be taught as a course and teaching methods that support CT be infused into all courses of the program. Global and national trends and policies need to be considered. For example, international development goals, disease patterns and burdens, employer expectations and needs, international best practices and standards, and availability of health facilities and clinical staff for clinicaleducation should guide the curriculum. Additionally, legal/regulatory bodies' requirements need to be adhered to. In the Ghanaian under graduate nursing context, the requirements of the Ghana Tertiary Education Commission (formerly of the National Accreditation Board), the Nursing and Midwifery Council of Ghana and the university in which the program is undertaken would be essential to consider.

6. ETHICAL CONSIDERATIONS

Research Ethics Committee approveal was obtained from the Health Research Ethics Committee of Stellenbosch University (Ref. No. FS17/05/106) and the university in which the study was conducted (name withheld to ensure the anonymity of participants). Written permission was sought from the dean of the selected school. All participants including students, nurse educators and preceptors provided informed consent. Given that this was a PAR, the owner of the authorship and the findings were made explicitly clear to the participants as suggested by Mash ( 2014 ). The names and the contributions of participants were kept confidential and the group was supported by the researcher throughout the study.

7. LIMITATION OF THE STUDY

The quality of a PAR is dependent on how the initiating researcher can unmask and diffuse power differentials. The power relational challenges inherent in many studies may be perpetuated (Scotland, 2012). Given that a hierarchical situation and power inequalities could arise because of the involvement of students, the students' representation was increased to form half of the cooperative inquiry group. Also, training of the cooperative inquiry group was carried out to address coercion, collaboration and partnership. The Nominal Group Technique was adopted for decision‐making to ensure that no one's view was disproportionately rated above others. In addition, the absence of one or two members at different times may have influenced the flow and consistency of ideas generated.

8. CONCLUSION

Conducting a study with the purpose of developing a framework of CT development is appropriate for different reasons. Consistent with the context of this study where the seniority tradition exists which may negatively influence the student–faculty relationship, this curriculum framework emphasized the importance of authentic interaction between students and the faculty in facilitating the CT skills of students. The recommended framework derived may suggest a wider implication for nursing schools and universities to provide CT‐based continuous professional development programs for their nurse faculty. Additionally, the study findings may have implications for monitoring and evaluation activities with the view of improving standard setting and teaching–learning experiences of students.

Based on this study, it is envisaged that nurse educators, who play a pivotal role in nursing education, will find reasons to refine their instructional practices. Also, further research focussing on different contexts of CT in Ghana may be useful. Most importantly, this framework may provide direction for how a curriculum can be predicated on CT, thereby removing arbitrariness.

AUTHOR CONTRIBUTIONS

All the authors made substantial contributions to the manuscript. CMB, ASVDM and JG conceived and designed the study. CMB collected data, analysed and drafted the manuscript. ASVDM and JG supervised the study and made critical revisions to the paper.

FUNDING INFORMATION

No external funding.

CONFLICT OF INTEREST STATEMENT

We do not have any conflict of interest to report.

ACKNOWLEDGEMENTS

We wish to acknowledge Victor Angbah for assisting in data collection. We also express our gratitude to the study participants. Furthermore, we express our profound gratitude to the authority and staff of the educational institution used for this study.

Boso, C. M. , van der Merwe, A. S. , & Gross, J. (2023). Curriculum framework to facilitate critical thinking skills of undergraduate nursing students: A cooperative inquiry approach . Nursing Open , 10 , 5129–5138. 10.1002/nop2.1748 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

DATA AVAILABILITY STATEMENT

• Amoako‐Sakyi, D. , & Amonoo‐Kuofi, H. (2015). Problem‐based learning in resource‐poor settings: Lessons from a medical school in Ghana . BMC Medical Education , 15 , 221–229. 10.1186/s12909-015-0501-4 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Baddeley, A. (2010). Working memory . Current Biology , 20 ( 4 ), R136–R140. [ PubMed ] [ Google Scholar ]
• Bell, S. A. , Rominski, S. , Bam, V. , Donkor, E. , & Lori, J. (2013). Analysis of nursing education in Ghana: Priorities for scaling‐up the nursing workforce . Nursing and Health Sciences , 15 ( 2 ), 244–249. 10.1111/nhs.12026 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Beresford, P. (2006). Making the connections with direct experience: From the Western Front to user‐controlled research . Educational Action Research , 14 ( 2 ), 161–169. 10.1080/09650790600717987 [ CrossRef ] [ Google Scholar ]
• Billings, D. M. , & Halstead, J. A. (2005). Teaching in nursing: A guide for faculty (2nd ed.). Elsevier Inc. [ Google Scholar ]
• Boozaripour, M. , Abbaszadeh, A. , Shahriari, M. , & Borhani, F. (2018). Ethical values in nurse education perceived by students and educators . Nursing Ethics , 25 ( 2 ), 253–263. 10.1177/0969733017707009 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Boso, C. M. , & Gross, J. J. (2015). Nurse educators' perceptions of critical thinking in developing countries: Ghana as a case study . Advances in Medical Education and Practice , 6 , 555–560. 10.2147/AMEP.S88942 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Boso, C. M. , van der Merwe, A. S. , & Gross, J. (2020). Critical thinking skills of nursing students: Observations of classroom instructional activities . Nursing Open , 7 ( 2 ), 581–588. 10.1002/nop2.426 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Boso, C. M. , van der Merwe, A. S. , & Gross, J. (2021a). Analysis of examination questions to determine cognitive level of critical thinking skills required (Manuscript in preparation) .
• Boso, C. M. , van der Merwe, A. S. , & Gross, J. (2021b). Critical thinking disposition of nursing students: A quantitative investigation . Nurse Education in Practice Education in Practice , 55 , 103167. 10.1016/j.nepr.2021.103167 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Boso, C. M. , van der Merwe, A. S. , & Gross, J. (2021c). Students' and educators' experiences with instructional activities towards critical thinking skills acquisition in a nursing school . International Journal of Africa Nursing Sciences , 14 , 100293. 10.1016/j.ijans.2021.100293 [ CrossRef ] [ Google Scholar ]
• Butler, H. A. (2012). Halpern critical thinking assessment predicts real world outcomes of critical thinking . Applied Cognitive Psychology , 26 , 721–729. 10.1002/acp.2851 [ CrossRef ] [ Google Scholar ]
• Chan, Z. C. Y. (2013). A systematic review of critical thinking in nursing education . Nurse Education Today , 33 ( 3 ), 236–240. 10.1016/j.nedt.2013.01.007 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chen, G.‐M. , & Chung, J. (2002). Seniority and superiority: A case analysis of decision making in a Taiwanese religious group . Intercultural Communication Studies , 11 ( 1 ), 41–56. [ Google Scholar ]
• Davies, M. , & Barnett, R. (2015). The palgrave handbook of critical thinking in higher education (1st ed.). Palgrave Macmillan. [ Google Scholar ]
• Donkor, N. T. , & Andrews, L. D. (2011). Ethics, culture and nursing practice in Ghana . International Nursing Review , 58 ( 1 ), 109–114. 10.1111/j.1466-7657.2010.00852.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dozier, A. L. , Gilbert, B. G. , Hughes, V. W. , Mathis, D. P. , & Jenkins, L. J. (2021). The use of active learning strategies during the COVID‐19 pandemic to promote critical thinking . The ABNF Journal , 32 ( 1 ), 12–16. [ Google Scholar ]
• Dunne, G. (2015). Beyond critical thinking to critical being: Criticality in higher education and life . International Journal of Educational Research , 71 , 86–99. 10.1016/j.ijer.2015.03.003 [ CrossRef ] [ Google Scholar ]
• Duron, R. , Limbach, B. , & Waugh, W. (2006). Critical thinking framework for any discipline . Interrnational Journal of Teaching and Learning in Higher Education , 17 ( 2 ), 160–166. [ Google Scholar ]
• Dwyer, C. P. , Hogan, M. J. , & Stewart, I. (2014). An integrated critical thinking framework for the 21st century . Thinking Skills and Creativity , 12 , 43–52. 10.1016/j.tsc.2013.12.004 [ CrossRef ] [ Google Scholar ]
• Facione, P. A. (1990). Critical thinking: A statement of consensus for purposes of educational assessment and instruction . California Academic Press. [ Google Scholar ]
• Gholami, M. , Moghadam, P. K. , Mohammadipoor, F. , Tarahi, M. J. , Sak, M. , Toulabi, T. , & Pour, A. H. H. (2016). Comparing the effects of problem‐based learning and the traditional lecture method on critical thinking skills and metacognitive awareness in nursing students in a critical care nursing course . Nurse Education Today , 45 , 16–21. 10.1016/j.nedt.2016.06.007 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hart, E. , & Bond, M. (1995). Action research for health and social care . Open University Press. [ Google Scholar ]
• Harvey, N. , & Holmes, C. (2012). Nominal group technique (NGT): An effective method of obtaining group consensus . International Journal of Nursing Practice , 18 ( 2 ), 188–194. 10.1111/j.1440-172X.2012.02017.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Huitt, W. (2011). Bloom et al.'s taxonomy of the cognitive domain. Educational psychology interactive . Valdosta State University. http://www.edpsycinteractive.org/topics/cognition/bloom.html [pdf]. [ Google Scholar ]
• Koshy, E. , Valsa, K. , & Waterman, H. (2011). Action research in healthcare . SAGE Publications Ltd. [ Google Scholar ]
• Mangena, A. , & Chabeli, M. M. (2005). Strategies to overcome obstacles in the facilitation of critical thinking in nursing education . Nurse Education Today , 25 ( 4 ), 291–298. 10.1016/j.nedt.2005.01.012 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mash, B. (2014). African primary care research: Participatory action research . African Journal of Primary Health Care and Family Medicaine , 6 ( 1 ), 42–46. 10.4102/phcfm.v6i1.585 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mash, B. , & Meulenberg‐Buskens, I. (2001). “Holding it lightly”: The co‐operative inquiry group: A method for developing educational materials . Medical Education , 35 , 1108–1114. [ PubMed ] [ Google Scholar ]
• Nursing and Midwifery Council of Ghana . (2015). Curriculum for the registered general nursing (RGN) program: Based on the semester course unit system . Nursing and Midwifery Council of Ghana. [ Google Scholar ]
• Raymond, C. L. , & Profetto‐McGrath, J. (2005). Nurse educators’ critical thinking: Reflection and measurement . Nurse Education in Practice , 5 , 209–217. 10.1016/j.nepr.2004.10.004 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Raymond, C. , Profetto‐McGrath, J. , Myrick, F. , & Strean, W. B. (2017). An integrative review of the concealed connection: Nurse educators' critical thinking . Journal of Nursing Education , 56 ( 11 ), 648–654. 10.3928/01484834-20171020-03 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Raymond, C. , Profetto‐McGrath, J. , Myrick, F. , & Strean, W. B. (2018). Balancing the seen and unseen: Nurse educator as role model for critical thinking . Nurse Education in Practice , 31 , 41–47. 10.1016/j.nepr.2018.04.010 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rolfe, G. (1996). Going to extremes: Action research, grounded practice and the theory‐practice gap in nursing . Journal of Advanced Nursing , 24 ( 6 ), 1315–1320. 10.1111/j.1365-2648.1996.tb01040.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Shell, R. (2001). Perceived barriers to teaching for critical thinking by nursing faculty . Nursing and Health Care Perspectives , 22 ( 6 ), 286–291. [ PubMed ] [ Google Scholar ]
• South African Nursing Council . (2014). Competencies for a nurse educator . South African Nursing Council. [ Google Scholar ]
• Talley, B. (2006). Nurses and nursing education in Ghana: Creating collaborative opportunities . International Nursing Review , 53 ( 1 ), 47–51. 10.1111/j.1466-7657.2006.00431.x [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ward‐Smith, P. (2020). The nurse as a critical thinking expert . Urologic Nursing , 40 ( 1 ), 5. 10.7257/1053-816X.2020.40.1.5 [ CrossRef ] [ Google Scholar ]
• Whiteman, K. , Yaglowski, J. , & Stephens, K. (2021). Quality improvement: Critical thinking tools for quality improvement projects . Critical Care Nurse , 41 ( 2 ), e1–e9. 10.4037/con2021914 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wilmot, E. M. , Kumfo, J. , Danso‐Mensah, D. , & Antwi‐Danso, S. (2013). An Investigation into the factors that contribute to nurse/midwife trainees' poor performance in the final licencing examination in Ghana .
• World Health Organization . (2009). Nursing and midwifery human resources for health: Global standards for the initial education of professional nurses and midwives . World Health Organization. [ Google Scholar ]

• {{region.title}}
• Others (a full list)

{{region_detail.title}} back

{{region_detail.text}}

• {{person.title}}
• {{organization.title}}

{{person_detail.title}} back

{{person_detail.text}}

{{organization_detail.title}} back

{{organization_detail.text}}

coming soon

{{series.title}}.

{{series.description | limitTo:140}}

March 27, 2024

Russian offensive campaign assessment, march 27, 2024.

March 27, 2024, 5:10pm ET

Click here to see ISW’s interactive map of the Russian invasion of Ukraine. This map is updated daily alongside the static maps present in this report.

Click here to see ISW’s 3D control of terrain topographic map of Ukraine. Use of a computer (not a mobile device) is strongly recommended for using this data-heavy tool.

Click here to access ISW’s archive of interactive time-lapse maps of the Russian invasion of Ukraine. These maps complement the static control-of-terrain map that ISW produces daily by showing a dynamic frontline. ISW will update this time-lapse map archive monthly.

Note: The data cut-off for this product was 2:15pm ET on March 27. ISW will cover subsequent reports in the March 28 Russian Offensive Campaign Assessment.

The UN Human Rights Monitoring Mission in Ukraine (HRMMU) released its 38th report on the human rights situation in Ukraine on March 26, confirming several of ISW’s longstanding assessments about Russia’s systematic violations of international human rights and humanitarian law in occupied territories and towards Ukrainian prisoners of war (POWs). [1] The HRMMU report details activities between December 1, 2023 and February 29 2024, and includes new findings about Russia’s abuse of Ukrainian POWs during this timeframe, based on interviews with 60 recently released male POWs. [2] Nearly all of the POWs that HRMMU interviewed detailed how they were tortured by Russian forces with beatings and electric shocks and threatened with execution, and over half of the interviewees experienced sexual violence. HRMMU also reported that it has evidence of Russian forces executing at least 32 POWs in 12 different incidents during the reporting period and independently verified three of the executions. ISW observed open-source evidence of several POW executions during this reporting period: the execution of three Ukrainian POWs near Robotyne, Zaporizhia Oblast on December 27, 2023; the execution of one Ukrainian POW near Klishchiivka, Donetsk Oblast on February 9, 2024; the executions of three Ukrainian POWs near Robotyne, the execution of six Ukrainian POWs near Avdiivka, Donetsk Oblast, and the executions of two Ukrainian POWs near Vesele, Donetsk Oblast on or around February 18, 2024; and the execution of nine Ukrainian POWs near Ivanivske, Donetsk Oblast, on February 25. [3] The summary execution and mistreatment of POWs is a violation of Article 3 of the Geneva Convention relative to the Treatment of Prisoners of War. [4] The HRMMU report also details the forced Russification of Ukrainian populations in occupied areas, including the imposition of Russian political, legal, and administrative systems onto occupied Ukraine in violation of Russia’s international legal obligations as an occupying power. [5] ISW has reported at length on the specifics of Russia’s illegal occupation of Ukraine, consistent with the findings of the UN HRMMU report. [6]

Russian officials are tying the US and the West to a broader set of “terrorist” attacks against Russia following the Crocus City Hall attack, likely to intensify rhetoric about alleged Western and Ukrainian threats to generate greater domestic support for the war in Ukraine. The Russian Investigative Committee and Prosecutor General’s Office stated on March 27 that they will consider an appeal from the Russian State Duma to investigate American and Western financing and organization of terrorist attacks against Russia. [7] The Russian Investigative Committee, Prosecutor General’s Office, and the Duma Deputies that made the appeal did not explicitly reference the Crocus City Hall attack. [8] Kremlin officials have previously tied Ukraine and the West to the Crocus City Hall attack but have yet to make a formal accusation, and the Kremlin may refrain from issuing an official accusation as all available evidence continues to show that the Islamic State (IS) is very likely responsible for the attack. [9] Russian officials routinely describe Ukrainian military strikes against legitimate military targets in occupied Ukraine and Russia as terrorism and consistently claim that Western actors help organize these strikes. [10] The Kremlin likely aims to seize on wider Russian social fears and anger following the Crocus City Hall attack by portraying Ukraine, the US, and the West as immediate terrorist threats. The Kremlin likely hopes that perceptions of Ukrainian and Western involvement in the Crocus City Hall attack will increase domestic support for the war in Ukraine, and Russian officials will likely invoke a broader view of what they consider terrorism to further cast Ukrainians as terrorists and the West as a sponsor of terrorism. [11] The Kremlin may still formally accuse Ukraine of conducting the Crocus City Hall attack if it believes that these other informational efforts are insufficient to generate the domestic response it likely desires. [12]

Russian authorities are increasing legal pressure against migrants in Russia following recent Russian officials’ proposals for harsher, measures against migrant communities in response to the March 22 Crocus City Hall attack. BBC News Russian Service stated that there has been a significant increase in the number of cases related to violations of the rules of entry for foreign citizens into Russia following the Crocus City Hall attack. [13] BBC News Russian Service reported on March 27 that 784 such cases have been registered since the morning of March 25, as compared with 1,106 during the entire previous week. A Russian lawyer who often works with Tajik citizens reportedly told BBC News Russian Service that over 100 people waited for a Moscow district court to hear their cases on March 25 alone and that Russian authorities are especially targeting migrants from Tajikistan during searches. BBC News Russian Service reported that representatives of the Tajik diaspora in Russia are expecting Russian authorities to conduct a large wave of deportations following the Crocus City Hall attack. A Russian insider source claimed on March 27 that unspecified actors gave the Moscow Ministry of Internal Affairs (MVD) an “unspoken” order to “not spare” migrants and for MVD employees to use their own judgement in the field. [14] The insider source claimed that a source suggested that Russian authorities are not preparing to conduct raids on migrant communities but will apply the “strictest measures” to migrants in “controversial situations.” Kremlin newswire TASS stated on March 27 that Russian police and Rosgvardia conducted a raid at the Wildberries warehouse in Elektrostal, Moscow Oblast to check the documents of migrant workers, and Russian opposition outlet Baza reported that Russian authorities detained 21 people during the raid. [15] Several Russian ultranationalist milbloggers complained that the way Russian-language schools in Tajikistan are teaching about Russia’s historical imperial occupation of Tajikistan is discouraging Tajik migrants from integrating into Russian society, essentially blaming migrants for the alienation that Russian society subjects them to. [16] Select Russian officials recently called for the introduction of several anti-migrant policies, which Russian authorities are unlikely to enact given Russia’s reliance on migrants for its force generation and labor needs. [17] Russian authorities may continue the practice of raiding migrant workplaces and increase crackdowns at border crossings to temporarily placate emotional cries for retribution following the March 22 attack as the Kremlin continues to develop a cogent and practical response.

Key Takeaways:

• The UN Human Rights Monitoring Mission in Ukraine (HRMMU) released its 38th report on the human rights situation in Ukraine on March 26, confirming several of ISW’s longstanding assessments about Russia’s systematic violations of international human rights and humanitarian law in occupied territories and towards Ukrainian prisoners of war (POWs).
• Russian officials are tying the US and the West to a broader set of “terrorist” attacks against Russia following the Crocus City Hall attack, likely to intensify rhetoric about alleged Western and Ukrainian threats to generate greater domestic support for the war in Ukraine.
• Russian authorities are increasing legal pressure against migrants in Russia following recent Russian officials’ proposals for harsher, measures against migrant communities in response to the March 22 Crocus City Hall attack.
• Russian forces recently made confirmed advances near Avdiivka and southwest of Donetsk City on March 27.
• Russian Storm-Z personnel continue to complain about their poor treatment by the Russian Ministry of Defense (MoD) as the MoD tries to posture efficacy in its force generation and social benefit allocation system.

We do not report in detail on Russian war crimes because these activities are well-covered in Western media and do not directly affect the military operations we are assessing and forecasting. We will continue to evaluate and report on the effects of these criminal activities on the Ukrainian military and the Ukrainian population and specifically on combat in Ukrainian urban areas. We utterly condemn Russian violations of the laws of armed conflict and the Geneva Conventions and crimes against humanity even though we do not describe them in these reports.  

• Russian Main Effort – Eastern Ukraine (comprised of two subordinate main efforts)
• Russian Subordinate Main Effort #1 – Capture the remainder of Luhansk Oblast and push westward into eastern Kharkiv Oblast and encircle northern Donetsk Oblast
• Russian Subordinate Main Effort #2 – Capture the entirety of Donetsk Oblast
• Russian Supporting Effort – Southern Axis
• Russian Air, Missile, and Drone Campaign
• Russian Mobilization and Force Generation Efforts
• Russian Technological Adaptations
• Activities in Russian-occupied areas
• Ukrainian Defense Industrial Base Efforts

Russian Information Operations and Narratives

• Significant Activity in Belarus

Russian Main Effort – Eastern Ukraine

Russian Subordinate Main Effort #1 – Luhansk Oblast (Russian objective: Capture the remainder of Luhansk Oblast and push westward into eastern Kharkiv Oblast and northern Donetsk Oblast)

Positional engagements continued along the Kupyansk-Svatove-Kreminna line on March 27, but there were no confirmed changes to the frontline in this area. Ukrainian and Russian sources stated that positional engagements continued northeast of Kupyansk near Synkivka and Lake Lyman; southeast of Kupyansk near Ivanivka; west of Kreminna near Terny and Yampolivka; and south of Kreminna near Bilohorivka. [18] Russian milbloggers claimed that Russian forces advanced near Terny, but ISW has not observed visual confirmation of this claim. [19] Chechen Republic Head Ramzan Kadyrov stated that elements of the Chechen Akhmat Spetsnaz “Aida” detachment are operating near Bilohorivka. [20]

Ukrainian officials reported that Russian forces struck Kharkiv City with a D-30 universal joint glide munition (UMPB), a guided glide bomb, on March 27. [21] Ukrainian officials noted that the strike was the first Russian glide bomb strike against Kharkiv City since the beginning of the full-scale invasion in 2022. [22] Ukrainian Kharkiv Oblast Military Administration Head Oleh Synehubov stated that the UMPB D-30 has a range of up to 90 kilometers and that Russian forces can launch the bomb from aircraft or ground-based Smerch multiple rocket launch systems (MLRS). [23] Russian forces struck Myrnohrad, Donetsk Oblast with three UMPB D-30SN guided glide bombs on March 10. [24]

Russian Subordinate Main Effort #2 – Donetsk Oblast (Russian objective: Capture the entirety of Donetsk Oblast, the claimed territory of Russia’s proxies in Donbas)

Russian forces reportedly advanced west of Bakhmut, although there were no confirmed changes to the frontline in the area on March 27. Russian milbloggers claimed that Russian forces advanced west of Bakhmut along a railway line and a section of the O0506 (Khromove-Chasiv Yar) highway by 1.15 kilometers in depth and 1.85 kilometers in width. [25] A Russian milblogger claimed that elements of the 98th Airborne (VDV) Division are advancing near Ivanivske and are within 500 meters of the city limits of Chasiv Yar (west of Bakhmut). [26] Russian Defense Minister Sergei Shoigu credited elements of the Russian 102nd Motorized Rifle Regiment (150th Motorized Rifle Division, 8th Combined Arms Army [CAA], Southern Military District [SMD]) with seizing Ivanivske on March 24, although ISW has yet to observe visual evidence confirming that Russian forces have seized Ivanivske. [27] Positional fighting continued northeast of Bakhmut near Vesele; northwest of Bakhmut near Bohdanivka; west of Bakhmut near Ivanivske; southwest of Bakhmut near Klishchiivka and Andriivka; and south of Bakhmut near Shumy and Pivdenne. [28] A Ukrainian military observer reported that Russian forces have intensified transfers of equipment and personnel along ground lines of communication (GLOCs) through Kadiivka, Pervomaisk, and Popasna (all east of Bakhmut), but did not specify the destination of these transfers. [29] Kadiivka, Pervomaisk, and Popasna all lie along the T0504 Luhansk City-Bakhmut highway that runs directly from the Russian rear in occupied Luhansk Oblast into Bakhmut, however.

Russian forces recently advanced west of Avdiivka amid continued positional fighting in the area on March 27. Geolocated footage published on March 27 indicates that Russian forces recently advanced within Berdychi (northwest of Avdiivka) and in Orlivka (west of Avdiivka). [30] Russian milbloggers claimed that Russian forces entered Semenivka (northwest of Avdiivka) and are attacking Ukrainian positions within the settlement but that Ukrainian forces are actively counterattacking in the area. [31] A Russian milblogger claimed that Russian forces advanced 200 meters west of Orlivka on the western bank of the Durna River, 200 meters west of Tonenke (west of Avdiivka), 200 meters in the direction of Umanske (west of Avdiivka), 300 meters south of Tonenke towards Pervomaiske (southwest of Avdiivka), and 100 meters south of Nevelske (southwest of Avdiivka). [32] ISW has not observed visual confirmation of these claims. Positional fighting continued northwest of Avdiivka near Berdychi and Semenivka; west of Avdiivka near Orlivka, Tonenke, and Umanske; and southwest of Avdiivka near Vodyane, Nevelske, and Pervomaiske. [33]

Russian forces recently advanced southwest of Donetsk City amid continued positional fighting west and southwest of Donetsk City on March 27. Geolocated footage published on March 27 indicates that Russian forces recently advanced within central Novomykhailivka (southwest of Donetsk City). [34] Positional fighting continued west of Donetsk City near Heorhiivka and Krasnohorivka and southwest of Donetsk City near Novomykhailivka and Pobieda. [35] Elements of the Russian 5th Motorized Rifle Brigade (1st Donetsk People’s Republic [DNR] Army Corps [AC]) are reportedly operating near Krasnohorivka. [36]

Positional engagements continued south of Velyka Novosilka near Staromayorske and Urozhaine in the Donetsk-Zaporizhia Oblast border area on March 27. [37]

Russian Supporting Effort – Southern Axis (Russian objective: Maintain frontline positions and secure rear areas against Ukrainian strikes)

Positional engagements continued in western Zaporizhia Oblast on March 27, but there were no confirmed changes to the frontline. Positional engagements continued near Robotyne, near Mala Tokmachka (northeast of Robotyne), northeast of Novoprokopivka (south of Robotyne), and northwest of Verbove (east of Robotyne). [38] Elements of the Russian 71st Motorized Rifle Regiment (42nd Motorized Rifle Division, 58th Combined Arms Army [CAA], Southern Military District [SMD]) reportedly continue operating within Robotyne. [39]

Positional engagements continued in east (left) bank Kherson Oblast, including near Krynky, on March 27. [40]

Russian Air, Missile, and Drone Campaign (Russian Objective: Target Ukrainian military and civilian infrastructure in the rear and on the frontline)

Russian forces conducted a series of drone and missile strikes against Ukraine on the night of March 26 to 27 and on March 27. The Ukrainian Air Force reported that Russian forces launched 13 Shahed-136/131 drones from Kursk Oblast and that Ukrainian forces shot down 10 drones over Kharkiv, Sumy, and Kyiv oblasts on the night of March 26 to 27. [41] Ukrainian officials reported that Russian drones struck civilian infrastructure in Izyum, Kharkiv Oblast. [42] Ukrainian Kharkiv Oblast Head Oleh Synehubov stated that a Russian Kh-35U subsonic anti-ship cruise missile struck Kharkiv City on the morning of March 27. [43] Ukraine’s Eastern Air Command reported that Ukrainian forces shot down an unspecified Russian cruise missile over Dnipropetrovsk Oblast on March 27. [44] Ukrainian officials stated that Russian forces struck an industrial enterprise in Mykolaiv City with an Iskander-M ballistic missile on the afternoon of March 27. [45]

Ukraine’s Southern Operational Command Spokesperson Colonel Nataliya Humenyuk stated that Russian forces have stored “several dozen” Zircon missiles in military facilities in occupied Crimea. [46] Ukrainian Air Force Spokesperson Major Ilya Yevlash stated that Ukrainian air defense systems, such as Patriot and SAMP/T systems, can intercept Zircon missiles when they slow down to about 3,700 kilometers per hour on approach to a target. [47]

Russian Mobilization and Force Generation Efforts (Russian objective: Expand combat power without conducting general mobilization)

Russian Storm-Z personnel continue to complain about their poor treatment by the Russian Ministry of Defense (MoD) as the MoD tries to present the efficacy of its force generation and social benefit allocation system. Russian opposition outlet Mobilization News posted a video appeal from Storm-Z fighters from Kaluga Oblast on March 27 wherein one fighter claimed that after signing contracts with the Russian MoD, Russian command sent a Storm-Z unit of 230 people to the frontline, of whom only 38 survived combat. [48] The Storm-Z fighter complained that he has been unable to receive combat veteran status or promised payments from the Russian authorities for his service. [49] Mobilization News released another video on March 27 wherein relatives of killed and wounded Storm-Z fighters complain to Russian President Vladimir Putin that Russian authorities have not issued the Storm-Z fighters combat status or granted payments in the event of their death or injury in Ukraine. [50] The relatives of the Storm-Z fighters blamed the Russian MoD and Defense Minister Sergei Shoigu for the poor treatment and lack of benefits for Storm-Z fighters. The Russian MoD relies heavily on Storm-Z recruits from penal colonies to carry out costly infantry-led frontal assaults against Ukrainian positions and is very unlikely to address complaints concerning their poor treatment. The Russian MoD claimed on March 27 that it is issuing electronic combat veteran certificates and streamlining and digitizing the process for veterans to obtain payments and social benefits — but these privileges evidently do not apply evenly to all personnel who have signed contracts with the Russian MoD. [51]

Russian news outlet Vedemosti reported that US-sanctioned Russian company Baikal Electronics is struggling to domestically package semiconductor chips to produce processors and that over half of its domestically produced processors are defective. [52] Vedemosti reported that Baikal Electronics began to experiment with domestically packaging chips in Russia at the end of 2021 and that outdated equipment and a lack of experienced employees caused the large amount of processor defects.

Russian Technological Adaptations (Russian objective: Introduce technological innovations to optimize systems for use in Ukraine)

Russian drone developer Albatross LLC told Kremlin newswire TASS that Russian forces used the Albatross M5 long-range reconnaissance drones to guide aviation and artillery strikes while repelling recent pro-Ukrainian Russian raids into Belgorod Oblast. [53] Albatross LLC noted that the modernized Albatross M5 drone has a maximum range of 60-80 kilometers.

Russian state news outlet RIA Novosti reported that Russian T-72B3, T-72B3M, T-80BVM, and T-90M tanks operating in Ukraine use Reflex-M guided weapon systems with the Invar-M/M1 anti-tank guided missiles to strike Ukrainian and Western-made vehicles. [54]

Ukrainian Defense Industrial Efforts (Ukrainian objective: Develop its defense industrial base to become more self-sufficient in cooperation with US, European, and international partners)

ISW is not publishing coverage of Ukrainian defense industrial efforts today.

Activities in Russian-occupied areas (Russian objective: Consolidate administrative control of annexed areas; forcibly integrate Ukrainian citizens into Russian sociocultural, economic, military, and governance systems)

ISW is not publishing coverage of activities in Russian-occupied areas of Ukraine today.

Russian officials are weaponizing international responses to the Crocus City Hall attack to accuse the West of espousing Russophobic policies and to baselessly blame Ukraine of involvement in the attack. Russian Ambassador to Austria Dmitry Lyubinsky claimed on March 27 that while the Austrian government reacted to the Crocus City Hall attack, it did not use the words “terrorist attack” or condemn the attack. [55] Lyubinsky accused Austria of having “taken a very special position in its hypocrisy” and a “daze of permissiveness” towards Ukraine and reiterated the Kremlin narrative baselessly connecting Ukraine to the attack. Russian Foreign Ministry Spokesperson Maria Zakharova reported that Russia has received 24-hour non-stop words of support from around the globe following the attack, but immediately pivoted to accuse Ukraine of involvement in the attack and blame NATO members of monopolizing the global fight against terror. [56]

Significant activity in Belarus (Russian efforts to increase its military presence in Belarus and further integrate Belarus into Russian-favorable frameworks and Wagner Group activity in Belarus)

Nothing significant to report.

Note: ISW does not receive any classified material from any source, uses only publicly available information, and draws extensively on Russian, Ukrainian, and Western reporting and social media as well as commercially available satellite imagery and other geospatial data as the basis for these reports. References to all sources used are provided in the endnotes of each update.

[1] https://ukraine.un.org/sites/default/files/2024-03/2024-03-26%20OHCHR%2038th%20Periodic%20Report.pdf

[2] https://ukraine.un.org/en/264368-un-says-russia-continues-torture-execute-ukrainian-pows

[3] https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-february-20-2024 ; https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-february-18-2024 ; https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-february-10-2024 ; https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-january-3-2024 ; https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-february-20-2024 ; https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-december-27-2023

[4] https://www.ohchr.org/en/instruments-mechanisms/instruments/geneva-convention-relative-treatment-prisoners-war

[5] https://ukraine.un.org/sites/default/files/2024-03/2024-03-26%20OHCHR%2038th%20Periodic%20Report.pdf

[6] https://www.understandingwar.org/sites/default/files/24-210-01%20ISW%20Occupation%20playbook.pdf

[7] https://t.me/tass_agency/240300 ; https://t.me/astrapress/52521 ; https://t.me/tass_agency/240322

[8] https://ria dot ru/20240327/rassledovanie-1936142056.html ; https://meduza dot io/news/2024/03/27/deputaty-gosdumy-potrebovali-ot-sk-rassledovat-akty-terrorizma-kotorye-ssha-sovmestno-so-stranami-nato-i-spetssluzhbami-ukrainy-osuschestvlyayut-v-rossii

[9] https://isw.pub/UkrWar032324 ; https://isw.pub/UkrWar032424 ; https://isw.pub/UkrWar032524 ; https://isw.pub/UkrWar032624

[10] https://t.me/tass_agency/239253%C2%A0;%C2%A0https://isw.pub/UkrWar020624%C2%A0;%C2%A0https://isw.pub/UkrWar031824%C2%A0 ; https://www.reuters.com/world/europe/putin-calls-ukrainian-attack-belgorod-terrorism-promises-more-strikes-2024-01-01/ ; https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-march-23-2024 ; https://isw.pub/RusCampaignOct10

[11] https://isw.pub/UkrWar032324

[12] https://isw.pub/UkrWar032324

[13] https://t.me/bbcrussian/62850

[14] https://t.me/vchkogpu/47045

[15] https://t.me/bazabazon/26432 ; https://t.me/bazabazon/26440 ; https://meduza dot io/news/2024/03/27/politsiya-i-rosgvardiya-priehali-s-reydom-na-sklad-wildberries-v-podmoskovnoy-elektrostali-u-rabotnikov-proveryayut-dokumenty-nekotoryh-uvozyat-v-voenkomat ; https://t.me/tass_agency/240303 ; https://t.me/tass_agency/240290

[16] https://t.me/rybar/58588 ; https://t.me/notes_veterans/16295 ; https://t.me/historiographe/12011 ; https://t.me/voenacher/63252

[17] https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-march-26-2024 ; https://understandingwar.org/backgrounder/russian-offensive-campaign-assessment-march-24-2024

[18] https://www.facebook.com/GeneralStaff.ua/posts/pfbid02rxTJAPqhSGh5mqY7C4XDTQiRjiVX25K4Tmx6tT6GCypPhjw8tmKBZAmRa5jaETbGl ; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02ReTBwNLG8czu42xB89ixKbv1WzZE2LqsgMcXwngSeHHpRjAXoaR3esPk1eCxZiZ8l ; https://t.me/mod_russia/37036 ; https://t.me/wargonzo/19025 ; https://t.me/luhanskaVTSA/17835 ; https://t.me/wargonzo/19025

[19] https://t.me/dva_majors/38313 ; https://t.me/DnevnikDesantnika/8702

[20] https://t.me/RKadyrov_95/4620

[21] https://suspilne dot media/714544-zelenskij-zminiv-sekretara-rnbo-zvit-oon-sodo-stracenih-ukrainskih-polonenih-763-den-vijni-onlajn/?anchor=live_1711553688&utm_source=copylink&utm_medium=ps ; https://armyinform dot com.ua/2024/03/27/boyeprypas-yakym-rosiyany-vdaryly-po-harkovu-mozhe-letity-na-vidstan-do-90-km-oleg-synyegubov/

[22] https://suspilne dot media/714544-zelenskij-zminiv-sekretara-rnbo-zvit-oon-sodo-stracenih-ukrainskih-polonenih-763-den-vijni-onlajn/?anchor=live_1711553688&utm_source=copylink&utm_medium=ps; https://armyinform dot com.ua/2024/03/27/boyeprypas-yakym-rosiyany-vdaryly-po-harkovu-mozhe-letity-na-vidstan-do-90-km-oleg-synyegubov/

[23] https://armyinform dot com.ua/2024/03/27/boyeprypas-yakym-rosiyany-vdaryly-po-harkovu-mozhe-letity-na-vidstan-do-90-km-oleg-synyegubov/

[24] https://isw.pub/UkrWar031024

[25] https://t.me/RVvoenkor/64758; https://t.me/basurin_e/10068 ; https://t.me/rusich_army/13845

[26] https://t.me/rusich_army/13845

[27] https://t.me/mod_russia/37029 ; https://www.understandingwar.org/backgrounder/russian-offensive-campaign-assessment-march-23-2024

[28] https://t.me/mod_russia/37044 ; https://t.me/mod_russia/37051 ; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02Lh7wn9dDbMDZcCSUP4kHDoHuABYPPUB5vnfakuyQw21x2MKXQ1fcsLqAgYeuSQVWl ; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02rxTJAPqhSGh5mqY7C4XDTQiRjiVX25K4Tmx6tT6GCypPhjw8tmKBZAmRa5jaETbGl; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02ReTBwNLG8czu42xB89ixKbv1WzZE2LqsgMcXwngSeHHpRjAXoaR3esPk1eCxZiZ8l ; https://t.me/DnevnikDesantnika/8702 ; https://t.me/negumanitarnaya_pomosch_Z/16170 ; https://t.me/wargonzo/19025 ; https://t.me/rusich_army/13845 ;

[29] https://t.me/samotniyskhid/4868

[30] https://t.me/creamy_caprice/4888; https://t.me/kultshturmovika_ukraine/1773 ; https://t.me/creamy_caprice/4889; https://t.me/c/1595839251/3625; https://x.com/GeoConfirmed/status/1772981767139430744?s=20

[31] https://t.me/DnevnikDesantnika/8702 ; https://t.me/dva_majors/38373 ; https://t.me/negumanitarnaya_pomosch_Z/16183 ; https://t.me/DnevnikDesantnika/8724 ; https://t.me/rybar/58575

[32] https://t.me/DnevnikDesantnika/8720

[33] https://www.facebook.com/GeneralStaff.ua/posts/pfbid02rxTJAPqhSGh5mqY7C4XDTQiRjiVX25K4Tmx6tT6GCypPhjw8tmKBZAmRa5jaETbGl; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02ReTBwNLG8czu42xB89ixKbv1WzZE2LqsgMcXwngSeHHpRjAXoaR3esPk1eCxZiZ8l ; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02Lh7wn9dDbMDZcCSUP4kHDoHuABYPPUB5vnfakuyQw21x2MKXQ1fcsLqAgYeuSQVWl ; https://t.me/mod_russia/37044 ; https://t.me/mod_russia/37051 ; https://t.me/dva_majors/38313 ; https://t.me/DnevnikDesantnika/8720 ; https://t.me/DnevnikDesantnika/8702 ; https://t.me/wargonzo/19025 ; https://t.me/voenkorKotenok/55225

[34] https://t.me/tivaz_artillery/3650; https://t.me/creamy_caprice/4893

[35] https://www.facebook.com/GeneralStaff.ua/posts/pfbid02Lh7wn9dDbMDZcCSUP4kHDoHuABYPPUB5vnfakuyQw21x2MKXQ1fcsLqAgYeuSQVWl ; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02rxTJAPqhSGh5mqY7C4XDTQiRjiVX25K4Tmx6tT6GCypPhjw8tmKBZAmRa5jaETbGl; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02ReTBwNLG8czu42xB89ixKbv1WzZE2LqsgMcXwngSeHHpRjAXoaR3esPk1eCxZiZ8l ; https://t.me/dva_majors/38313 ; https://t.me/wargonzo/19025 ; https://t.me/boris_rozhin/118101 ; https://t.me/voenkorKotenok/55225

[36] https://t.me/boris_rozhin/118105

[37] https://www.facebook.com/GeneralStaff.ua/posts/pfbid02rxTJAPqhSGh5mqY7C4XDTQiRjiVX25K4Tmx6tT6GCypPhjw8tmKBZAmRa5jaETbGl; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02ReTBwNLG8czu42xB89ixKbv1WzZE2LqsgMcXwngSeHHpRjAXoaR3esPk1eCxZiZ8l ; https://t.me/mod_russia/37044 ; https://t.me/mod_russia/37052 ; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02Lh7wn9dDbMDZcCSUP4kHDoHuABYPPUB5vnfakuyQw21x2MKXQ1fcsLqAgYeuSQVWl

[38] https://www.facebook.com/GeneralStaff.ua/posts/pfbid02Lh7wn9dDbMDZcCSUP4kHDoHuABYPPUB5vnfakuyQw21x2MKXQ1fcsLqAgYeuSQVWl ; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02rxTJAPqhSGh5mqY7C4XDTQiRjiVX25K4Tmx6tT6GCypPhjw8tmKBZAmRa5jaETbGl; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02ReTBwNLG8czu42xB89ixKbv1WzZE2LqsgMcXwngSeHHpRjAXoaR3esPk1eCxZiZ8l ; https://t.me/SJTF_Odes/7591 ; https://t.me/rybar/58575 ; https://t.me/dva_majors/38313 ; https://t.me/DnevnikDesantnika/8715 ; https://t.me/DnevnikDesantnika/8692 ; https://t.me/wargonzo/19025

[39] https://t.me/batalyon15/4045

[40] https://www.facebook.com/GeneralStaff.ua/posts/pfbid02rxTJAPqhSGh5mqY7C4XDTQiRjiVX25K4Tmx6tT6GCypPhjw8tmKBZAmRa5jaETbGl; https://www.facebook.com/GeneralStaff.ua/posts/pfbid02ReTBwNLG8czu42xB89ixKbv1WzZE2LqsgMcXwngSeHHpRjAXoaR3esPk1eCxZiZ8l ; https://t.me/dva_majors/38313

[41] https://t.me/kpszsu/12330

[42] https://t.me/pgo_gov_ua/22717 ; https://armyinform.com dot ua/2024/03/27/vijska-rf-atakuvaly-izyum-shahedamy-poshkodzheno-gimnaziyu-poraneno-ohoronczya/ ; https://t.me/synegubov/8827?single

[43] https://t.me/synegubov/8827

[44] https://www.facebook.com/pvkshid/posts/pfbid0LGmUtBDdzmxud8zZ23FDoN8eKarYJkLS6YrsSUzB62HVo7uSrXWhxPxnnzAhuSUyl

[45] https://t.me/mykolaivskaODA/8840 ; https://t.me/dsns_mykolaiv/4948 ; https://t.me/SJTF_Odes/7600

[46] https://armyinform.com dot ua/2024/03/27/u-sylah-oborony-povidomyly-pro-kilkist-rosijskyh-czyrkoniv-u-krymu/

[47] https://armyinform.com dot ua/2024/03/27/u-povitryanyh-sylah-povidomyly-pro-sposoby-zbyttya-rosijskyh-czyrkoniv/

[48] https://t.me/mobilizationnews/18111

[49] https://t.me/mobilizationnews/18111

[50] https://t.me/mobilizationnews/18114

[51] https://t.me/mod_russia/37031

[52] https://www.severreal.org/a/bolshe-poloviny-rossiyskih-protsessorov-baykal-okazalis-brakovannymi/32879476.html ; https://www.vedomosti dot ru/technology/articles/2024/03/26/1027924-razrabotchik-protsessorov-baikal-lokalizuet-odin-iz-etapov-proizvodstva

[53] https://t.me/tass_agency/240240 ; https://t.me/tass_agency/240241 ; https://t.me/tass_agency/240268

[54] https://ria dot ru/20240327/rakety-1936068479.html

[55] https://t.me/RusBotWien_RU/4869

[56] https://t.me/MID_Russia/38112

Reading List

{{currentView.title}}

{{nextView.title}}

Get Notified

Currently receiving 0 of 2 possible notifications for this sort of content.

• LOCATION Ukraine
• LOCATION Russia