The Value of Critical Thinking in Nursing

Gayle Morris, BSN, MSN

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

Male nurse checking on a patient

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

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

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.

Portrait of Jenna Liphart Rhoads, Ph.D., RN

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.

Portrait of Nicholas McGowan, BSN, RN, CCRN

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.

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What is Critical Thinking in Nursing? (Explained W/ Examples)

What-is-Critical-thinking-in-nursing-levels-important-why-how-process-fundamental

Last updated on August 23rd, 2023

Critical thinking is a foundational skill applicable across various domains, including education, problem-solving, decision-making, and professional fields such as science, business, healthcare, and more.

It plays a crucial role in promoting logical and rational thinking, fostering informed decision-making, and enabling individuals to navigate complex and rapidly changing environments.

In this article, we will look at what is critical thinking in nursing practice, its importance, and how it enables nurses to excel in their roles while also positively impacting patient outcomes.

how-to-apply-critical-thinking-in-nursing-concepts-for-critical-thinker

What is Critical Thinking?

Critical thinking is a cognitive process that involves analyzing, evaluating, and synthesizing information to make reasoned and informed decisions.

It’s a mental activity that goes beyond simple memorization or acceptance of information at face value.

Critical thinking involves careful, reflective, and logical thinking to understand complex problems, consider various perspectives, and arrive at well-reasoned conclusions or solutions.

Key aspects of critical thinking include:

  • Analysis: Critical thinking begins with the thorough examination of information, ideas, or situations. It involves breaking down complex concepts into smaller parts to better understand their components and relationships.
  • Evaluation: Critical thinkers assess the quality and reliability of information or arguments. They weigh evidence, identify strengths and weaknesses, and determine the credibility of sources.
  • Synthesis: Critical thinking involves combining different pieces of information or ideas to create a new understanding or perspective. This involves connecting the dots between various sources and integrating them into a coherent whole.
  • Inference: Critical thinkers draw logical and well-supported conclusions based on the information and evidence available. They use reasoning to make educated guesses about situations where complete information might be lacking.
  • Problem-Solving: Critical thinking is essential in solving complex problems. It allows individuals to identify and define problems, generate potential solutions, evaluate the pros and cons of each solution, and choose the most appropriate course of action.
  • Creativity: Critical thinking involves thinking outside the box and considering alternative viewpoints or approaches. It encourages the exploration of new ideas and solutions beyond conventional thinking.
  • Reflection: Critical thinkers engage in self-assessment and reflection on their thought processes. They consider their own biases, assumptions, and potential errors in reasoning, aiming to improve their thinking skills over time.
  • Open-Mindedness: Critical thinkers approach ideas and information with an open mind, willing to consider different viewpoints and perspectives even if they challenge their own beliefs.
  • Effective Communication: Critical thinkers can articulate their thoughts and reasoning clearly and persuasively to others. They can express complex ideas in a coherent and understandable manner.
  • Continuous Learning: Critical thinking encourages a commitment to ongoing learning and intellectual growth. It involves seeking out new knowledge, refining thinking skills, and staying receptive to new information.

Definition of Critical Thinking

Critical thinking is an intellectual process of analyzing, evaluating, and synthesizing information to make reasoned and informed decisions.

What is Critical Thinking in Nursing?

Critical thinking in nursing is a vital cognitive skill that involves analyzing, evaluating, and making reasoned decisions about patient care.

It’s an essential aspect of a nurse’s professional practice as it enables them to provide safe and effective care to patients.

Critical thinking involves a careful and deliberate thought process to gather and assess information, consider alternative solutions, and make informed decisions based on evidence and sound judgment.

This skill helps nurses to:

  • Assess Information: Critical thinking allows nurses to thoroughly assess patient information, including medical history, symptoms, and test results. By analyzing this data, nurses can identify patterns, discrepancies, and potential issues that may require further investigation.
  • Diagnose: Nurses use critical thinking to analyze patient data and collaboratively work with other healthcare professionals to formulate accurate nursing diagnoses. This is crucial for developing appropriate care plans that address the unique needs of each patient.
  • Plan and Implement Care: Once a nursing diagnosis is established, critical thinking helps nurses develop effective care plans. They consider various interventions and treatment options, considering the patient’s preferences, medical history, and evidence-based practices.
  • Evaluate Outcomes: After implementing interventions, critical thinking enables nurses to evaluate the outcomes of their actions. If the desired outcomes are not achieved, nurses can adapt their approach and make necessary changes to the care plan.
  • Prioritize Care: In busy healthcare environments, nurses often face situations where they must prioritize patient care. Critical thinking helps them determine which patients require immediate attention and which interventions are most essential.
  • Communicate Effectively: Critical thinking skills allow nurses to communicate clearly and confidently with patients, their families, and other members of the healthcare team. They can explain complex medical information and treatment plans in a way that is easily understood by all parties involved.
  • Identify Problems: Nurses use critical thinking to identify potential complications or problems in a patient’s condition. This early recognition can lead to timely interventions and prevent further deterioration.
  • Collaborate: Healthcare is a collaborative effort involving various professionals. Critical thinking enables nurses to actively participate in interdisciplinary discussions, share their insights, and contribute to holistic patient care.
  • Ethical Decision-Making: Critical thinking helps nurses navigate ethical dilemmas that can arise in patient care. They can analyze different perspectives, consider ethical principles, and make morally sound decisions.
  • Continual Learning: Critical thinking encourages nurses to seek out new knowledge, stay up-to-date with the latest research and medical advancements, and incorporate evidence-based practices into their care.

In summary, critical thinking is an integral skill for nurses, allowing them to provide high-quality, patient-centered care by analyzing information, making informed decisions, and adapting their approaches as needed.

It’s a dynamic process that enhances clinical reasoning , problem-solving, and overall patient outcomes.

What are the Levels of Critical Thinking in Nursing?

Levels-of-Critical-Thinking-in-Nursing-3-three-level

The development of critical thinking in nursing practice involves progressing through three levels: basic, complex, and commitment.

The Kataoka-Yahiro and Saylor model outlines this progression.

1. Basic Critical Thinking:

At this level, learners trust experts for solutions. Thinking is based on rules and principles. For instance, nursing students may strictly follow a procedure manual without personalization, as they lack experience. Answers are seen as right or wrong, and the opinions of experts are accepted.

2. Complex Critical Thinking:

Learners start to analyze choices independently and think creatively. They recognize conflicting solutions and weigh benefits and risks. Thinking becomes innovative, with a willingness to consider various approaches in complex situations.

3. Commitment:

At this level, individuals anticipate decision points without external help and take responsibility for their choices. They choose actions or beliefs based on available alternatives, considering consequences and accountability.

As nurses gain knowledge and experience, their critical thinking evolves from relying on experts to independent analysis and decision-making, ultimately leading to committed and accountable choices in patient care.

Why Critical Thinking is Important in Nursing?

Critical thinking is important in nursing for several crucial reasons:

Patient Safety:

Nursing decisions directly impact patient well-being. Critical thinking helps nurses identify potential risks, make informed choices, and prevent errors.

Clinical Judgment:

Nursing decisions often involve evaluating information from various sources, such as patient history, lab results, and medical literature.

Critical thinking assists nurses in critically appraising this information, distinguishing credible sources, and making rational judgments that align with evidence-based practices.

Enhances Decision-Making:

In nursing, critical thinking allows nurses to gather relevant patient information, assess it objectively, and weigh different options based on evidence and analysis.

This process empowers them to make informed decisions about patient care, treatment plans, and interventions, ultimately leading to better outcomes.

Promotes Problem-Solving:

Nurses encounter complex patient issues that require effective problem-solving.

Critical thinking equips them to break down problems into manageable parts, analyze root causes, and explore creative solutions that consider the unique needs of each patient.

Drives Creativity:

Nursing care is not always straightforward. Critical thinking encourages nurses to think creatively and explore innovative approaches to challenges, especially when standard protocols might not suffice for unique patient situations.

Fosters Effective Communication:

Communication is central to nursing. Critical thinking enables nurses to clearly express their thoughts, provide logical explanations for their decisions, and engage in meaningful dialogues with patients, families, and other healthcare professionals.

Aids Learning:

Nursing is a field of continuous learning. Critical thinking encourages nurses to engage in ongoing self-directed education, seeking out new knowledge, embracing new techniques, and staying current with the latest research and developments.

Improves Relationships:

Open-mindedness and empathy are essential in nursing relationships.

Critical thinking encourages nurses to consider diverse viewpoints, understand patients’ perspectives, and communicate compassionately, leading to stronger therapeutic relationships.

Empowers Independence:

Nursing often requires autonomous decision-making. Critical thinking empowers nurses to analyze situations independently, make judgments without undue influence, and take responsibility for their actions.

Facilitates Adaptability:

Healthcare environments are ever-changing. Critical thinking equips nurses with the ability to quickly assess new information, adjust care plans, and navigate unexpected situations while maintaining patient safety and well-being.

Strengthens Critical Analysis:

In the era of vast information, nurses must discern reliable data from misinformation.

Critical thinking helps them scrutinize sources, question assumptions, and make well-founded choices based on credible information.

How to Apply Critical Thinking in Nursing? (With Examples)

critical-thinking-skill-in-nursing-skills-how-to-apply-critical-thinking

Here are some examples of how nurses can apply critical thinking.

Assess Patient Data:

Critical Thinking Action: Carefully review patient history, symptoms, and test results.

Example: A nurse notices a change in a diabetic patient’s blood sugar levels. Instead of just administering insulin, the nurse considers recent dietary changes, activity levels, and possible medication interactions before adjusting the treatment plan.

Diagnose Patient Needs:

Critical Thinking Action: Analyze patient data to identify potential nursing diagnoses.

Example: After reviewing a patient’s lab results, vital signs, and observations, a nurse identifies “ Risk for Impaired Skin Integrity ” due to the patient’s limited mobility.

Plan and Implement Care:

Critical Thinking Action: Develop a care plan based on patient needs and evidence-based practices.

Example: For a patient at risk of falls, the nurse plans interventions such as hourly rounding, non-slip footwear, and bed alarms to ensure patient safety.

Evaluate Interventions:

Critical Thinking Action: Assess the effectiveness of interventions and modify the care plan as needed.

Example: After administering pain medication, the nurse evaluates its impact on the patient’s comfort level and considers adjusting the dosage or trying an alternative pain management approach.

Prioritize Care:

Critical Thinking Action: Determine the order of interventions based on patient acuity and needs.

Example: In a busy emergency department, the nurse triages patients by considering the severity of their conditions, ensuring that critical cases receive immediate attention.

Collaborate with the Healthcare Team:

Critical Thinking Action: Participate in interdisciplinary discussions and share insights.

Example: During rounds, a nurse provides input on a patient’s response to treatment, which prompts the team to adjust the care plan for better outcomes.

Ethical Decision-Making:

Critical Thinking Action: Analyze ethical dilemmas and make morally sound choices.

Example: When a terminally ill patient expresses a desire to stop treatment, the nurse engages in ethical discussions, respecting the patient’s autonomy and ensuring proper end-of-life care.

Patient Education:

Critical Thinking Action: Tailor patient education to individual needs and comprehension levels.

Example: A nurse uses visual aids and simplified language to explain medication administration to a patient with limited literacy skills.

Adapt to Changes:

Critical Thinking Action: Quickly adjust care plans when patient conditions change.

Example: During post-operative recovery, a nurse notices signs of infection and promptly informs the healthcare team to initiate appropriate treatment adjustments.

Critical Analysis of Information:

Critical Thinking Action: Evaluate information sources for reliability and relevance.

Example: When presented with conflicting research studies, a nurse critically examines the methodologies and sample sizes to determine which study is more credible.

Making Sense of Critical Thinking Skills

What is the purpose of critical thinking in nursing.

The purpose of critical thinking in nursing is to enable nurses to effectively analyze, interpret, and evaluate patient information, make informed clinical judgments, develop appropriate care plans, prioritize interventions, and adapt their approaches as needed, thereby ensuring safe, evidence-based, and patient-centered care.

Why critical thinking is important in nursing?

Critical thinking is important in nursing because it promotes safe decision-making, accurate clinical judgment, problem-solving, evidence-based practice, holistic patient care, ethical reasoning, collaboration, and adapting to dynamic healthcare environments.

Critical thinking skill also enhances patient safety, improves outcomes, and supports nurses’ professional growth.

How is critical thinking used in the nursing process?

Critical thinking is integral to the nursing process as it guides nurses through the systematic approach of assessing, diagnosing, planning, implementing, and evaluating patient care. It involves:

  • Assessment: Critical thinking enables nurses to gather and interpret patient data accurately, recognizing relevant patterns and cues.
  • Diagnosis: Nurses use critical thinking to analyze patient data, identify nursing diagnoses, and differentiate actual issues from potential complications.
  • Planning: Critical thinking helps nurses develop tailored care plans, selecting appropriate interventions based on patient needs and evidence.
  • Implementation: Nurses make informed decisions during interventions, considering patient responses and adjusting plans as needed.
  • Evaluation: Critical thinking supports the assessment of patient outcomes, determining the effectiveness of intervention, and adapting care accordingly.

Throughout the nursing process , critical thinking ensures comprehensive, patient-centered care and fosters continuous improvement in clinical judgment and decision-making.

What is an example of the critical thinking attitude of independent thinking in nursing practice?

An example of the critical thinking attitude of independent thinking in nursing practice could be:

A nurse is caring for a patient with a complex medical history who is experiencing a new set of symptoms. The nurse carefully reviews the patient’s history, recent test results, and medication list.

While discussing the case with the healthcare team, the nurse realizes that the current treatment plan might not be addressing all aspects of the patient’s condition.

Instead of simply following the established protocol, the nurse independently considers alternative approaches based on their assessment.

The nurse proposes a modification to the treatment plan, citing the rationale and evidence supporting the change.

This demonstrates independent thinking by critically evaluating the situation, challenging assumptions, and advocating for a more personalized and effective patient care approach.

How to use Costa’s level of questioning for critical thinking in nursing?

Costa’s levels of questioning can be applied in nursing to facilitate critical thinking and stimulate a deeper understanding of patient situations. The levels of questioning are as follows:

  • 15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)
  • Nursing Concept Map (FREE Template)
  • Clinical Reasoning In Nursing (Explained W/ Example)
  • 8 Stages Of The Clinical Reasoning Cycle
  • How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples
  • What is the “5 Whys” Technique?
  • What Are Socratic Questions?

Critical thinking in nursing is the foundation that underpins safe, effective, and patient-centered care.

Critical thinking skills empower nurses to navigate the complexities of their profession while consistently providing high-quality care to diverse patient populations.

Reading Recommendation

Potter, P.A., Perry, A.G., Stockert, P. and Hall, A. (2013) Fundamentals of Nursing

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critical thinking nursing foundation

Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Affiliations.

  • 1 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group Quantitative Psychology (2017-SGR-269), University of Barcelona, Barcelona, Spain.
  • 2 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group on Gender, Identity and Diversity (2017-SGR-1091), University of Barcelona, Barcelona, Spain.
  • 3 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.
  • 4 Multidisciplinary Nursing Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain.
  • PMID: 33029860
  • DOI: 10.1111/nup.12332

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.

Keywords: critical thinking; critical thinking attitudes; nurse education; nursing care; nursing research.

© 2020 John Wiley & Sons Ltd.

  • Attitude of Health Personnel*
  • Education, Nursing / methods
  • Nursing Process
  • Nursing Research / methods

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  • PREI-19-007-B/School of Nursing. Faculty of Medicine and Health Sciences. University of Barcelona

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Critical Thinking

Critical Thinking in Nursing

Maggie Convey and Sarah Malo

All nursing regulatory bodies and associations cite the importance of active, critical thinking in all clinical contexts. Nursing is not a profession of complacency. In your undergraduate experience, you will have direction and opportunities to practice you critical thinking, clinical reasoning, and clinical judgement skills in all nursing courses. There is a clear connection between knowledge and knowing, critical thinking and the application of such knowledge into the role of the nurse, as seen below (Raymond-Seniuk & Profetto McGrath, 2017).

critical thinking nursing foundation

Nursing care and practice comes from thinking about and identifying knowledge from a nursing encounter, considering the nursing role, and considering the broader context to promote action.

Critical Thinking Indicators

From Rosalinda Alfaro-Lefevre (2019), personal critical thinking indicators offer an opportunity to reflect on your current thinking patterns.

critical thinking nursing foundation

Engaging and questioning your current practice is a form of  self-reflection. Honest and ongoing evaluation of your own progress is a necessity in nursing. Self-reflection can be fostered by asking yourself the following questions: What am I doing well? How am I doing well? What might I benefit from improving or changing? How might I go about doing so?

Reflecting on your own values, assumptions, biases, and thinking are effective ways to improve the quality of your thinking.

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About the Authors

name: Maggie Convey

name: Sarah Malo

Foundations for Success in Nursing: Manual Copyright © 2021 by Maggie Convey and Sarah Malo. All Rights Reserved.

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

critical thinking nursing foundation

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?

critical thinking nursing foundation

Critical thinking definition

critical thinking nursing foundation

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.

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critical thinking nursing foundation

Critical Thinking: Where to Begin

critical thinking nursing foundation

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  • For Home Schooling and Home Study

If you are new to critical thinking or wish to deepen your conception of it, we recommend you review the content below and bookmark this page for future reference.

Our Conception of Critical Thinking...

getting started with critical thinking

"Critical thinking is 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. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness..."

"Critical thinking is self-guided, self-disciplined thinking which attempts to reason at the highest level of quality in a fairminded way. People who think critically attempt, with consistent and conscious effort, to live rationally, reasonably, and empathically. They are keenly aware of the inherently flawed nature of human thinking when left unchecked. They strive to diminish the power of their egocentric and sociocentric tendencies. They use the intellectual tools that critical thinking offers – concepts and principles that enable them to analyze, assess, and improve thinking. They work diligently to develop the intellectual virtues of intellectual integrity, intellectual humility, intellectual civility, intellectual empathy, intellectual sense of justice and confidence in reason. They realize that no matter how skilled they are as thinkers, they can always improve their reasoning abilities and they will at times fall prey to mistakes in reasoning, human irrationality, prejudices, biases, distortions, uncritically accepted social rules and taboos, self-interest, and vested interest.

They strive to improve the world in whatever ways they can and contribute to a more rational, civilized society. At the same time, they recognize the complexities often inherent in doing so. They strive never to think simplistically about complicated issues and always to consider the rights and needs of relevant others. They recognize the complexities in developing as thinkers, and commit themselves to life-long practice toward self-improvement. They embody the Socratic principle: The unexamined life is not worth living , because they realize that many unexamined lives together result in an uncritical, unjust, dangerous world."

Why Critical Thinking?

critical thinking nursing foundation

The Problem:

Everyone thinks; it is our nature to do so. But much of our thinking, left to itself, is biased, distorted, partial, uninformed, or down-right prejudiced. Yet the quality of our lives and that of what we produce, make, or build depends precisely on the quality of our thought. Shoddy thinking is costly, both in money and in quality of life. Excellence in thought, however, must be systematically cultivated.

A Brief Definition:

Critical thinking is the art of analyzing and evaluating thinking with a view to improving it. The Result: 

  A well-cultivated critical thinker:

  • raises vital questions and problems, formulating them clearly and precisely;
  • gathers and assesses relevant information, using abstract ideas to interpret it effectively;
  • comes to well-reasoned conclusions and solutions, testing them against relevant criteria and standards;
  • thinks openmindedly within alternative systems of thought, recognizing and assessing, as need be, their assumptions, implications, and practical consequences; and
  • communicates effectively with others in figuring out solutions to complex problems.

Critical thinking is, in short, self-directed, self-disciplined, self-monitored, and self-corrective thinking. It requires rigorous standards of excellence and mindful command of their use. It entails effective communication and problem-solving abilities, and a commitment to overcoming our native egocentrism and sociocentrism. Read more about our concept of critical thinking .

The Essential Dimensions of Critical Thinking

critical thinking nursing foundation

Our conception of critical thinking is based on the substantive approach developed by Dr. Richard Paul and his colleagues at the Center and Foundation for Critical Thinking over multiple decades. It is relevant to every subject, discipline, and profession, and to reasoning through the problems of everyday life. It entails five essential dimensions of critical thinking:

At the left is an overview of the first three dimensions. In sum, the elements or structures of thought enable us to "take our thinking apart" and analyze it. The intellectual standards are used to assess and evaluate the elements. The intellectual traits are dispositions of mind embodied by the fairminded critical thinker. To cultivate the mind, we need command of these essential dimensions, and we need to consistently apply them as we think through the many problems and issues in our lives.

The Elements of Reasoning and Intellectual Standards

critical thinking nursing foundation

To learn more about the elements of thought and how to apply the intellectual standards, check out our interactive model. Simply click on the link below, scroll to the bottom of the page, and explore the model with your mouse.

Why the Analysis of Thinking Is Important If you want to think well, you must understand at least the rudiments of thought, the most basic structures out of which all thinking is made. You must learn how to take thinking apart. Analyzing the Logic of a Subject When we understand the elements of reasoning, we realize that all subjects, all disciplines, have a fundamental logic defined by the structures of thought embedded within them. Therefore, to lay bare a subject’s most fundamental logic, we should begin with these questions:

critical thinking nursing foundation

Going Deeper...

critical thinking nursing foundation

The Critical Thinking Bookstore  

Our online bookstore houses numerous books and teacher's manuals , Thinker's Guides , videos , and other educational materials .  

Learn From Our Fellows and Scholars

Watch our Event Calendar , which provides an overview of all upcoming conferences and academies hosted by the Foundation for Critical Thinking. Clicking an entry on the Event Calendar will bring up that event's details, and the option to register. For those interested in online learning, the Foundation offers accredited online courses in critical thinking for both educators and the general public, as well as an online test for evaluating basic comprehension of critical thinking concepts . We are in the process of developing more online learning tools and tests to offer the community.  

Utilizing this Website

This website contains large amounts research and an online library of articles , both of which are freely available to the public. We also invite you to become a member of the Critical Thinking Community , where you will gain access to more tools and materials.  If you cannot locate a resource on a specific topic or concept, try searching for it using our Search Tool . The Search Tool is at the upper-right of every page on the website.

Book cover

  • © 2023

Key Competences and New Literacies

From Slogans to School Reality

  • Maria Dobryakova   ORCID: https://orcid.org/0000-0002-9475-5476 0 ,
  • Isak Froumin   ORCID: https://orcid.org/0000-0001-9228-3770 1 ,
  • Kirill Barannikov   ORCID: https://orcid.org/0000-0001-5182-9458 2 ,
  • Gemma Moss 3 ,
  • Igor Remorenko   ORCID: https://orcid.org/0000-0002-8775-4248 4 ,
  • Jarkko Hautamäki 5

Institute of Education, National Research University Higher School of Economics, Moscow, Russia

You can also search for this editor in PubMed   Google Scholar

Head of the Observatory of Higher Education Innovations, Jacobs University, Bremen, Germany

Moscow city university, moscow, russia, university college london, london, uk, university of helsinki, helsinki, finland.

  • Includes case studies from 8 countries on the competence-turn in the curriculum
  • Describes pedagogical approaches to foster 21st century skills
  • Outlines the components of environmental literacy

Part of the book series: UNIPA Springer Series (USS)

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Table of contents (15 chapters)

Front matter, introduction.

  • Maria Dobryakova, Isak Froumin

The World Is Changing, and Education Is Changing with It

A framework of key competences and new literacies.

  • Maria Dobryakova, Isak Froumin, Gemma Moss, Norbert Seel, Kirill Barannikov, Igor Remorenko

Canada (Ontario): A Unifying Theme for Canadian Education Is Equity

  • Michele Peterson-Badali, Elisabeth Rees-Johnstone, Evelyn Wilson, Bev Freedman, Denese Belchetz, Karen Grose et al.

China: Fostering Students with All-round Attainments in Moral, Intellectual, Physical and Aesthetic Grounding

  • Huanhuan Xia, You You

England: Knowledge, Competences and Curriculum Reform—Why the English Case Stands Out

  • Gemma Moss, Ann Hodgson, Susan Cousin

Republic of Korea: Cultivating Key Competences

  • Junehee Yoo, Euichang Choi, Dongil Kim, Kyunghee So, Chan-Jong Kim, Il Lee et al.

Finland: Improving Pupils’ Opportunities for Experiencing the Joy of Learning, for Deep Learning, and for Good Learning Achievement

  • Jarkko Hautamäki, Raisa Ahtiainen, Natalia Gustavson, Risto Hotulainen, Sirkku Kupiainen, Marja Tamm et al.

Poland: The Learning Environment that Brought About a Change

  • Maciej Jakubowski, Jerzy Wiśniewski

Twenty-First Century Skills and Learning: A Case Study of Developments and Practices in the United States

  • Michael Russell, Henry Braun, Binbin Zhu

Russian Federation: At a Conceptual Crossroads

  • Kirill Barannikov, Maria Dobryakova, Isak Froumin, Igor Remorenko

Pedagogical and School Practices to Foster Key Competences and Domain-General Literacy

  • Maria Dobryakova, Norbert Seel

A Modern Aspect of Instrumental Literacy: Coding

  • Suhas Parandekar, Eugeny Patarakin, Gulcan Yayla

How to Integrate New Literacy in the Curriculum—Example of Environmental Literacy

Maria Dobryakova

How Countries Reform Their Curricula to Support the Development of Key Competences

  • Kirill Barannikov, Igor Remorenko, Isak Froumin

This edited book is a unique comprehensive discussion of 21 st  century skills in education in a comparative perspective. It presents investigation on how eight very different countries (China, Canada, England, Finland, Poland, South Korea, the USA and Russia) have attempted to integrate key competences and new literacies into their curricula and balance them with the acquisition of disciplinary knowledge. Bringing together psychological, sociological, pedagogical approaches, the book also explores theoretical underpinnings of 21 st  century skills and offers a scalable solution to align multiple competency and literacy frameworks.

The book provides a conceptual framework for curriculum reform and transformation of school practice designed to ensure that every school graduate thrives in our technologically and culturally changing world. By providing eight empirical portraits of competence-driven curriculum reform, this book is greatresource to educational researchers and policy makers.

  • Learning Objectives
  • New Literacies
  • Canadian Education
  • Education in China
  • Education in the UK
  • Cultivating Key Competences
  • Education in Republic of Korea
  • Education in Finland
  • Education in Poland
  • Twenty-First Century Skills and Learning
  • Education in USA
  • Education in Russia
  • Key competencies
  • 21st Century Curriculum
  • Curriculum Reform
  • Transversal Competences
  • Functional Literacy
  • Digital literacy
  • Competence-based Education
  • Critical Thinking

Isak Froumin

Kirill Barannikov, Igor Remorenko

Jarkko Hautamäki

Maria Dobryakova  graduated from the Moscow School of Social and Economic Sciences and Manchester University (M.A. in Sociology) and defended her Ph.D. in social stratification at the Institute of Sociology of the Russian Academy of Sciences. Since 2006 and until 2022 she worked at the National Research University Higher School of Economics, where she headed and coordinated a number of large-scale projects in education, social sciences, as well as publications and translation projects. Prior to that, she had worked at the Independent Institute for Social Policy (as head of publications) and the Ford Foundation (Higher Education and Scholarship program). 

Isak Froumin  headed the Institute of education at the National Research University Higher School of Economics in Moscow (Russia)—the first graduate school of education in Russia—from 2009 to 2021. After beginning his career as a principal of Kransnoyarsk University Laboratory School  (Russia), he worked as the Lead Education Specialist at the World Bank, and the advisor to the Minister of Education and Science of Russian Federation. He is a fellow of the International Academy of Education.

Kirill A. Barannikov  is the vice-rector for strategy, Moscow City University. He is working in MCU since 2015 and has led a number of projects over Moscow schools and the university development. Among the most striking projects are the online platform for teachers to create curricula (www.prok.edu.ru), the electronic platform for assessing the quality of the educational environment (www.ecers.ru, www.sacers.ru), internet service for supporting and developing initiatives  (www.zamisli.pro). Over the past ten years, he headed the center for distance education of children with disabilities of the Pedagogical Academy of Postgraduate Education, the center of curricula design and standards of the Academy of Social Management. He coordinated over 40 research projects of the Department of Education of the City of Moscow, the Ministry of Education and Science of Russia. The main areas of interest are competency models in school education, issues of standardization and curricula design in an international context, change management in schools and universities. 

Jarkko Hautamäki  graduated from University of Helsinki (majors in experimental psychology and social psychology) and defended his Ph.D. Dissertation (Measurement and Distribution of Piagetian Stages of Thinking) in University Joensuu. He became a full professor in Special Education in Helsinki University, served also the dean and founded and directed Helsinki University Center for Educational Assessment. He is the honorary professor of Faculty of Psychology at Moscow State University, member of the Finnish Academy of Science and Letters and member of The Russian Academy of Educational Sciences. His research interests include human development and schooling for thinking, interventions and special education and applying the science of development into schooling. He lives in Helsinki, Finland. 

Gemma Moss  is the professor of Literacy at UCL Institute of Education. She has been the president of the British Educational Research Association (2015–17), was a member of the European Education Research Association Council (2016–18), was director of the Centre for Critical Education Studies at the Institute of Education (2007–11) and was director of the International Literacy Centre at the Institute of Education, UCL (2017-22).  Her main research interests are in literacy as a social practice; literacy policy; knowledge transfer and knowledge exchange; evidence-informed practice and curriculum design; pedagogy and new technologies; primary assessment; and gender and literacy attainment.  Her research includes running multi-site ethnographic case studies, combining quantitative and qualitative methods in innovative ways and using rapid evidence assessment systematic review processes to bring knowledge to bear on contentious questions in education, where funders require rapid answers.  

Igor M. Remorenko  has been holding the post of the rector of the Moscow City University since 2013. He has a Ph.D. and full-doctor degree in Education. From 2009 to 2011, he held the post of the director of the Department of the State Policy and Legal Regulations in Education, Department of the State Policy in Education, Department of the Strategic Development of the Ministry of Education and Science of the Russian Federation; supervised the top-priority national project “Education” and programs to support the innovative development of the higher education institutes. From 2011 to 2013, he is the deputy minister of Education and Science of the Russian Federation. He is the author of a number of the scientific publications, two monographs. He participates in the researches in the field of educational policy, development of managerial approaches in education and multiple international and national projects in the sphere of education.

Book Title : Key Competences and New Literacies

Book Subtitle : From Slogans to School Reality

Editors : Maria Dobryakova, Isak Froumin, Kirill Barannikov, Gemma Moss, Igor Remorenko, Jarkko Hautamäki

Series Title : UNIPA Springer Series

DOI : https://doi.org/10.1007/978-3-031-23281-7

Publisher : Springer Cham

eBook Packages : Education , Education (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023

Hardcover ISBN : 978-3-031-23280-0 Published: 23 August 2023

Softcover ISBN : 978-3-031-23283-1 Due: 23 September 2023

eBook ISBN : 978-3-031-23281-7 Published: 22 August 2023

Series ISSN : 2366-7516

Series E-ISSN : 2366-7524

Edition Number : 1

Number of Pages : VI, 426

Number of Illustrations : 18 b/w illustrations, 27 illustrations in colour

Topics : Curriculum Studies , Study and Learning Skills , International and Comparative Education , Educational Policy and Politics

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Reflective and critical thinking in nursing curriculum

O pensamento crítico-reflexivo nos currículos de enfermagem, el pensamiento reflexivo y crítico en los currículos de enfermería, maría antonia jiménez-gómez.

1 Universidad Nacional de Colombia, Facultad de Enfermería, Bogotá, Colombia.

Lucila Cárdenas-Becerril

2 Universidad Autónoma del Estado de México, Facultad de Enfermería, Toluca, México.

Margarita Betzabé Velásquez-Oyola

3 Universidad Nacional José Faustino Sánchez Carrión, Facultad de Medicina Humana, Huacho, Lima, Peru.

Marcela Carrillo-Pineda

4 Universidad de Antioquia, Facultad de Enfermería, Medellín, Colombia.

Leyvi Yamile Barón-Díaz

5 Universidad Nacional de Colombia, Facultad de Medicina, Bogotá, Colombia.

to evaluate the teaching of transversal competence of the Reflective and Critical Thinking that is fundamental in the decision-making and solution of nursing problems, in degree programs of public and private institutions in the Andean region.

multi-center, cross-sectional, exploratory-descriptive study, with mixed approach in 5 countries.

76 nursing programs participated in the study. The Reflective and Critical Thinking was found as a subject, subject content and didactic strategies. Of the 562 subjects reviewed, this type of thinking is found in 46% of the humanities area and 42% in the area of research and professional discipline. It is important to train teachers to achieve coherence between the pedagogical model approach, teaching strategies and evaluations.

Conclusion:

nursing programs in the Andean region contemplate the critical thinking as cognitive and personals skills of communication. They also use real situations analysis, supervised practice, simulation labs and specifically learning based in problems to develop the capacity to solve them, decision-making and develop communication skills, including analysis, synthesis and evaluation.

avaliar o ensino da competência transversal do pensamento crítico-reflexivo, fundamental na tomada de decisões e solução de problemas de enfermagem, nos programas de graduação de instituições públicas e privadas da região Andina.

Método:

estudo multicêntrico, transversal, exploratório-descritivo, com abordagem mista em cinco países.

Resultados:

76 programas de Enfermagem participaram do estudo. O pensamento crítico-reflexivo foi constatado como disciplina, conteúdo de disciplina e estratégias didáticas. Das 562 disciplinas revisadas, este tipo de pensamento se encontra em 46% da área de humanidades e 42% na área de pesquisa e profissional-disciplinar. Existe a necessidade de capacitar os docentes para obter coerência entre a proposta do modelo pedagógico, as estratégias didáticas e a avaliação.

Conclusão:

os programas de enfermagem da região Andina contemplam o pensamento crítico como habilidades cognitivas, de comunicação e pessoais. Da mesma forma, utilizam a análise de situações reais, estágio supervisionado, laboratórios de simulação e, principalmente, a aprendizagem baseada em problemas, com a finalidade de desenvolver a capacidade para solucionar problemas, tomar decisões e desenvolver habilidades comunicativas, incluindo análise, síntese e avaliação.

evaluar la enseñanza de la competencia transversal del Pensamiento Reflexivo y Crítico, fundamental en la toma de decisiones y en la solución de problemas de enfermería, en los programas de grado de instituciones públicas y privadas de la región Andina.

estudio multicéntrico, transversal, exploratorio-descriptivo, con abordaje mixto en 5 países.

76 programas de Enfermería participaron en el estudio. El Pensamiento Reflexivo y Crítico se encontró como asignatura, contenido de asignatura y estrategias didácticas. De las 562 asignaturas que han sido revisadas, este tipo de pensamiento se encuentra en el 46% del área de humanidades y el 42% en el área de investigación y profesional disciplinar. Está la necesidad de capacitar a los docentes para lograr coherencia entre el planteamiento del modelo pedagógico, las estrategias didácticas y la evaluación.

Conclusión:

los programas de enfermería de la región Andina contemplan el pensamiento crítico como habilidades cognitivas, de comunicación y personales. Asimismo, utilizan el análisis de situaciones reales, la práctica supervisada, los laboratorios de simulación y, principalmente, el aprendizaje basado en problemas, con la finalidad de desarrollar la capacidad para solucionar los problemas, tomar decisiones y desarrollar habilidades comunicativas, incluyendo el análisis, la síntesis y la evaluación.

Introduction

Globalization brought with it changes in all aspects of life: social, political, economic and cultural. Moreover, the nursing profession is evolving, so that it is increasingly moving away from the biomedical model of care, focused on the instrumental, to focus on people’s health care, with primacy of dialogue and agreements between the professional and the person under care. As part of a multiprofessional team, this requires changes in the curricular proposal and, in turn, a qualifying teacher for a new profile of graduate, whereby reflection, self-criticism and professional responsibility are developed ( 1 ) .

Therefore, it is necessary to work intensely to reduce the dichotomies that are present in nursing programs, namely: between theory-practice; training and the reality of professional practice; and the student as a passive part of the teaching-learning process and the professional who is required, active, proactive, creative, analytical, with contextual perspective, flexible, with logical thinking, able to carry out a permanent and continuous search for information, able to contribute with his profession to the solution of health problems.

The General Conference of the United Nations Educational, Scientific and Cultural Organization (UNESCO), at its 38th session, held in Paris from 3 to 18 November 2015, “Recommendation about Adult Learning and Education” states in one of its objectives the need to develop people’s capacity to think critically and to act with autonomy and a sense of responsibility ( 2 ) .

Critical thinking (CT) is a process and a learning outcome ( 3 - 4 ) and the clinical judgment is the result of this process. The development of the clinical judgment (clinical reasoning skills) is one of the most important and challenging tasks of being a nurse. Clinical reasoning precedes clinical judgment and the decision-making that is important in professional and personal life.

In order to achieve professionals with reflective and critical thinking (RACT), it is necessary to make deep changes in the educational dynamics, in the teaching and student roles, in the use of pedagogy and didactics to transmit knowledge, the curricular structure, the strategies of teaching-learning. These changes are expected to be centered on the student, who must actively participate in the learning process in order to achieve greater development of his or her capacities for reasoning, self-learning, self-evaluation, self-management and self-regulation. Likewise, it is expected that teachers to be critical and creative, attending to individual ways of learning, encouraging the development of good thinking in the student ( 3 ) .

Literature points out that critical thinking is the “essential foundation for education, since it is the basis for adaptation to the individual, social and professional demands of daily life in the 21st century and beyond” ( 4 ) . The world changes fast and new realities arise, so there is a fundamental need of people to develop capabilities that allow them to respond and adapt themselves to these changes.

Critical thinking is “the process of seeking, obtaining, evaluating, analyzing, synthesizing and conceptualizing information as a guide, to develop self-conscious thinking and the ability to use this information by adding creativity and taking risks” ( 4 ) .

Authors pointed out one of the first definitions of critical thinking: “knowledge, skills and attitudes” ( 5 ) and, since the end of 1980, various strategies for its teaching have been discussed at all school levels ( 4 ) . On the other hand, authors point out the importance of generating opportunities to develop RACT in students. Therefore, some authors emphasize the importance of developing it in all health situations in favor of the patient ( 4 , 6 - 7 ) . The nursing professional developing RACT will know where, when and how to use their knowledge, skills, values and attitudes.

The motivation for nurse training in the Andean region became evident in the 1960s. In particular, Colombia generated the first degree program in 1958, which was approved in 1961. In the same period, Venezuela, Ecuador, and Peru initiated undergraduate programs; in the case of Bolivia, it happened only until 1970 ( 8 ) .

The 1980s were marked by the rise of postgraduate programs, increased development of research and the generation of knowledge. The 1990s saw a boom in graduate, specialization, masters, and doctoral programs, the latter especially in education. However, there were also more options for the qualification of nursing professionals for the teaching role. On the other hand, the Higher Education Quality Assurance System ( Sistema de Aseguramiento de la Calidad de la Educación Superior ) was implemented, as well as the Accreditation of the programs and the own regulations or nursing law emerged in each country of the region.

The first decade of the 21st century brought the development of the highest level of nursing education, the doctorate, and, with it, the generation of nursing knowledge in the region and its progress towards consolidation as a discipline ( 8 ) .

Throughout this journey, there was a permanent motivation for balance and congruence between the graduation profiles and the reality of the job, based on the permanent motivation for the adaptation of the curriculum, the teaching-learning strategies, the evaluation processes, and the teacher qualification to respond to this constantly changing context.

The literature ( 9 - 11 ) shows the need to expand the research in the area of education, to achieve greater development of research and to work in education and nursing policies and practices. On the other hand, the latter shows the need to implement and evaluate pedagogical and didactic strategies that help the student to develop a critical judgment, justified decision making, comprehensive memory and communicative competence ( 11 ) .

For its part, the Ibero-American Network for Research in Nursing Education ( Red Iberoamericana de Investigación en Educación en Enfermería - RIIEE), in 2011, identified as a research priority, “The development of RACT in nursing students”, within the tree of the problems detected in its research line Higher Education and Nursing. For the development of this research purpose, the Network suggested a multicenter macroproject with the theme “Strategies to develop the RACT in nursing students: situation in Latin America”. In fact, the conceptual paradigm refers to “critical theory and constructivism, since RACT is an analytical, cyclical, broad and systematic process, but not rigid; its analysis and interpretation allows to have elements for decision-making, as well as to make informed choices” ( 8 - 12 ) .

The project involves five of the six regions that make up the RIIEE: the Andean region (Bolivia, Colombia, Ecuador, Peru and Venezuela), Brazil, the Southern Cone, Europe, and Mexico and the Caribbean. The investigation is planned in three stages: 1. Diagnose; 2. Planning and implementation of interventions; and 3. Evaluation. The diagnostic stage includes: 1. The state of the art on scientific production in RACT and teaching strategies for its development; 2. Characterization of educational strategies for teaching the RACT collected in nursing literature; 3. To determine the development of the RACT competence in the different nursing curriculum; 4. To identify the educational strategies used by teachers to develop the competence of reflective critical thinking in nursing students; 5. To identify levels of critical thinking in nursing students according to the classification of Paul and Elder (unreflective thinker - master thinker). Objectives 4 and 5 are currently being developed.

The analysis of the “Scientific Production in RACT in Nursing in 1990-2012 in Ibero-America” produced among others the following conclusion: the formation of a critical reader and the investigative process are strategies that help university students to be critical and autonomous and to access more critically to the knowledge of the disciplinary area. For this, teachers are required to make of each moment and situation in the teaching-learning relationship an open forum for reflection, debate, questioning and contrasting of the different perspectives around the area of professional training and society’s problems ( 8 ) .

After reviewing the literature on the web of science by using the descriptors critical thinking and nursing, education and curriculum, it was not possible to find studies that analyzed the presence of RACT in the curriculum of nursing degree programs. However, it is very striking the motivation to analyze the importance of its development and studies that demonstrate its value, as well as the use of different and combined teaching-learning strategies to achieve the formation of RACT in nursing students.

This study was done with the purpose of to evaluate the teaching of transversal competence of the Reflective and Critical Thinking that is fundamental in the decision-making and solution of nursing problems, in degree programs of public and private institutions in the Andean region.

The coordinating group of RIIEE developed the research project from which the research groups of each country and region of the Network were made up, integrated by members of the Network and researchers in education and nursing, who are also teachers in Higher Education Institutions (HEI), and mostly with PhD academic level. The HEI in Nursing (HEIN) were identified through the Ministries of Education, the Associations of Schools and Universities of Nursing of each country and the Latin American Association of Schools and Universities of Nursing ( Asociación Latinoamericana de Escuelas y Facultades de Enfermería - ALADEFE).

The project was benefited from the Declaration of Helsinki (Ethical principles for medical research on human subjects) and the current ethics legislation in each country, was approved by the Ethics Committee of the University of Antioquia, Colombia, by Act No. CEI-FE 2015-25 on July 31, 2015. The respect for privacy and confidentiality were ensured to each Program Director, with the informed consent signed by each participant. The project was also sent to them and their understanding was guaranteed. In turn, we conceded the right to choose what information they wanted to share. Confidentiality was maintained by institutional coding. Finally, was given a deadline of 15 days to obtain the response of acceptance to participate.

The target population of this research were 187 undergraduate nursing programs in the Andean region: Bolivia (47), Colombia (47), Ecuador (21), Peru (62) and Venezuela (10). We considered only the nursing curriculum of the HEI, recognized by the Associations of Schools and Colleges of Nursing of each country or its counterpart, regardless of whether they were public or private. Resulting in the nursing curriculum of 76 Institutions that correspond to the 40.64% HEIN that teach undergraduate nursing in the Andean region: Bolivia (7), Colombia (38), Ecuador (11), Peru (14), and Venezuela (6). Due to the difficulty in obtaining the information, we checked web pages, contacted HEIN members, made contacts by telephone, in some cases, we made personal visits and, finally, the complete program was requested in PDF format for the complete the instrument of the research group. In addition, the HEIN did not refused to participate, but some institutions did not respond to the invitation. The result of this process: 30 institutions accepted to participate and provided the complete information, and out of 46 partial results were obtained. An HEIN database of the names, telephone numbers and e-mail addresses of the authorities in charge of managing the programs was created in order to follow up on their responses.

After identifying, during 2011 and 2012, the theoretical and conceptual framework of RACT from different authors and different perspectives (education, pedagogy, psychology and nursing), despite the abundance of literature about the subject, we concluded that the concept is very unclear from a nursing point of view ( 13 - 14 ) .

However, it was necessary to establish a concept that was accepted by the research group of the Network, that allowed to determine a starting point or consensus to carry out this work and, without detriment to seek some level of fidelity to the multiple approaches of the scholars of this research object, that was understandable for the group and reflected what was intended to be done in its research phases and stages.

The Network took as a theoretical framework the approaches made by Paul ( 15 ) and Paul; Elder ( 16 ) , the elements of the CT and the attitudes of the Critical Thinker proposed by these authors. With the material analyzed, RIIEE constructed the following concept: “Reflective and critical thinking is a complex, systematic and deliberate process of reasoning, self-directed and action-oriented. It is primary purpose to choose, based on intellectual and affective processes (cognitive, experiential and intuitive), the best response options that favor the solution of nursing problems, in well-defined contexts and in accordance with the ethical postulates of the profession that allow it to act with rationality and professional autonomy” ( 8 ) .

The research process included the conceptual and theoretical analysis of the curriculum, the updating of the context of research development in nursing education in each country of the region, the characterization of the HEIN and, finally, the results of the state of the art on teaching strategies for the development of the RACT 1990-2012, Andean region.

Once the exhaustive bibliographic review was carried out, the instrument was designed based on the concept of Stenhouse ( 17 ) , the curriculum as a macro concept that encompasses the socializing function of the school is at the same time pedagogical ideas, structure of contents in a particular form, precision of them, reflection of educational aspirations more difficult to translate in concrete terms and skills to promote in the students ( 16 ) . In Posner ( 18 ) , who raised the great number of phenomena involved in the curriculum; Gimeno-Sacristán; Pérez-Gómez ( 19 ) , there is five categories in which the definitions of curriculum can be articulated: as an organized knowledge structure, production technology system, instructional plan, set of learning experiences and problems solution.

Based on the aforementioned, the specific instrument for this investigation was constructed with three parts. The first with 10 items, with general information from the HEI or University. Each University is subdivided into Centers that are parted into Colleges and these are divided into programs: name, geographic location, type of institution, accreditation data, mission, vision, objectives, curricular guidelines for degree programs, web page, and data about who completed the instrument. The second, 28 items, for the College, School, Department or Nursing Program (typology to identify HEIN in the region), with the following subsections: general aspects of the nursing program, character within the institution, number of sites where the program is offered, accreditation data (date, resolution, and time of accreditation), program justification, mission, vision and objectives of the program, evaluation process, graduation profile, pedagogical model, number of hours and credits, curricular structure (nursing program subjects that correspond to each area or component). Finally, the general characteristics of the teachers: kind of affiliation with the institution, time worked, and maximum educational level achieved. The third, 9 items, for specific information about each of the subjects: name, component or area to which it belongs, number of hours and credits, type of subject (theoretical, practical and theoretical-practical), contents, teaching-learning methodologies and evaluation process.

The members of the research group carried out an analysis of the validity of the content of the instrument. Afterwards, the pilot test was conducted, starting with its implementation in each of the HEI in which the researchers worked; the results were analyzed and the corresponding adjustments were made in its structure. Subsequently, the adjusted instrument was tested with five members from the region, one from each country, but different from the research group. Because of this test, we decided to design a guide to facilitate the completion of the instrument and ensure objectivity in the collection of information, because of the language differences. It is possible to obtain the final version of the instrument from the authors of the project.

Each participant received the letter of invitation, the project, the informed consent, the instrument to collect the information and the corresponding guide for its completion in hands and by e-mail.

The information obtained was reviewed and, in some cases, it was necessary to request the complementation of some aspects of the instrument. Then we proceeded to codify the HEI or Universities and the HEIN. The information was included in Excel tables designed with the predetermined categories and subcategories, which were later incorporated into the SPSS statistical analysis program, version 19. The information was processed using descriptive statistics, with frequency distributions and average analysis, and analyzed by institution, by country and as an Andean region, according to the categories and subcategories determined, allowing comparisons between countries and conclusions to be drawn as a region.

The analysis of the information was carried out using the deductive-inductive method, considering the objectives of the project and the revised conceptual theoretical framework, with the aim of determining the presence of the RACT, explicit and implicit, in each categories, the coherence of the approaches between University-College-Program, the coherence between the objectives, contents, teaching-learning strategies and the evaluation process in each subject. In this sense, we analyzed the linearity or coherence with respect to what was proposed, developed and evaluated in relation to the RACT and, finally, the contradictions and inconsistencies found in the aforementioned approaches were pointed out. We considered national and international studies about the subject for the analysis and discussion of the results obtained, in addition to the documents mentioned above.

According to the information obtained by the research group, the Andean region has 2,552 HEI; 410 with character of universities and 160 are public, 220 are private and 14 are in special regime. There are 167 universities with nursing programs, 146 affiliated and recognized by the respective Associations of Schools and Colleges of Nursing in each country. The number of accredited nursing programs in the Andean region is 43: Colombia (20), Peru (20) and Bolivia (3). Precisely, of the 20 accredited institutions in Colombia, 11 already have their certifications renewed, which are of 8, 6 and 4 years; 5 and 6 years for Ecuador and 3 years for Peru. Bolivia is just beginning the process and Venezuela has no information about it.

The total population of HEIN by country was Bolivia 47, Colombia 42, Ecuador 21, Peru 62 and Venezuela 10. A total of 76 HEIN answered: Bolivia 7; Colombia 38; Ecuador 11; Peru 14 and Venezuela, 6. These institutions constituted the sample of the study.

Twenty-one of these institutions are certified: in Colombia 20 and in Bolivia 1; 12 did not include this information and 41 were not yet certificated. Of the total number of institutions that provided the information, 47 are public, 26 private and three do not know the information. Administratively, 36 are programs; 22 Colleges; 21 Schools and one Department.

The number of hours and credits of the programs showed considerable heterogeneity: the average number of hours was 5,552.3, corresponding on average to 232.11 credits. Regarding the number of hours per credit, the lowest is in Peru, which has 13 hours per credit, and the highest is in Colombia, with 48 hours corresponding to one credit. There are institutions that do not work with credits, especially in Bolivia; others did not included this information, among them Ecuador and Venezuela.

The main characteristics of the 912 teachers developing nursing programs in the Andean region are: 501 (54.9%) with a Specialist degree; 634 (69.51%) with a Master’s degree and 58 (6.35%) with a PhD; 249 (27.3%) with a postgraduate degree in Education.

From a general perspective, it should be noted that of the five countries in the region only Venezuela and Peru explicitly present the RACT in their Organic Law (OL) or Higher Education Law in terms of integral and permanent formation of reflective critical citizens (LOE, 2009, or Organic Law of Education, in Venezuela) ( 20 ) and (Law 30220, 2014, or University Law, in Peru) ( 21 ) .

The results of RACT’s presence are presented below: Universities or HEI; in Colleges, Programs, Schools and Departments, that is, in HEIN; and in the subjects.

When analyzing the information of the Universities or HEI, we found the RACT as direct mention, indirect mention and evidence of traditional positions was found. Directly, it was found as a training purpose in Bolivia, Colombia and Peru: receptor and analytical constructor, with critical conscience; as methodology to achieve it, in Colombia and Peru: “ promoting reasoning, the CT and creative”; as a result of learning in Ecuador and Venezuela: capable of solving problems, CT promoter.

The indirect mention was found as result in the five countries of the Region, as a strategy in Bolivia, Ecuador, Peru and Venezuela: integral formation, relation practical theory; and as objective in Colombia: future graduates with ethical conscience, autonomy, democratic spirit and highly qualified.

There are still traditional postures: teaching, evaluation as a final product, training in instrumental action, the educational process as providing knowledge.

By going a little deeper into the HEI, we found that 88% (38) consider the RACT: 63% (27) in the mission; 7% (3) in the vision; 51% (22) in the objectives and 30% (13) in the curricular guidelines. Among these, three defining categories were identified. The first, as a training purpose: prepare professionals and leaders with CT and social conscience . The second, as a methodological strategy to achieve its development: to develop and implement pedagogical methods that encourage reasoning, CT and creativity, and that encourage habits of discipline and productive work . And the third, as a result of the formation process that includes the subject: Training of critical, self-managed, creative and proactive men and women; and, moreover, refers to the projection and utility: with the promotion of CT and the generation of knowledge, thanks to the strengthening of critical analysis, anticipation and vision of the future and development of viable alternatives to the problems.

At HEIN, RACT is expressed in the graduation profile, objectives, curricular guidelines and mission. Table 1 shows the data summarized in relation to the number and percentage in which the RACT is presented in the subcategories and with regard to the total. The information recovered allows us to identify that the RACT ranks first with 38.3% in the graduation profile, followed by 35% both in the curricular guidelines and in the objectives; thirdly, is in the mission, 26.7%, and finally, with 11.7% it is in the vision. Bolivia has the highest percentage of presence in its curricular guidelines, followed by Colombia in its graduation profile, objectives, and mission, while Venezuela is in one before the last place with a 28% of presence in its mission and is not present in the profile or in the curricular guidelines. Peru has the last place and presents it only in the objectives of the programs.

In a cross-sectional view of what is proposed by curricular programs, three categories were identified to be highlighted. The first, the development of cognitive and personal skills, expressed as the training of professionals with scientific, technical, critical, analytical and reflective knowledge, as well as communication, oral and written expression skills; and referred to a critical, creative, participative, supportive, innovative and sensitive attitude towards social change.

The second, the way in which its development could be achieved, among which the research stands out: promote and develop research, generating knowledge in the different areas of nursing that contribute to universal science and the solution of health problems; and the use of technologies: learns permanently developing the capacity of abstraction, analysis, synthesis and using information technologies . The third, its finality, related to the ability of individuals, families and community groups to interfere and make decisions in the solution of health problems, to provide comprehensive care with the capacity to solve health problems in changing and emerging environments.

Concerning the pedagogical models expressed in the HEIN, a variety was found in the denomination. First of all, the constructivist approaches are highlighted in eight (8) Institutions, with some connotations as the model social-critical-constructivist and second, the cognitive - humanistic in four (4). Other models or approaches were also identified, among them: dialectic, technological, psychological, the problematic schools, the Active, Reflective, Dialectic, Innovative and Critical . Finally one institution works with the model based on the pillars of education , in which learning to know, learning to do, learning to be and learning to live together, which includes, educating for life, educating for life, educating for work, educating in society and for society ( 22 ) .

The RACT in the subjects of the programs of Nursing in the Andean region

Only 29 of the 76 HEIN participants in the study were able to obtain information on subjects (38.15%), and 22 (75.86%) of these in nursing programs, RACT was present in different elements of the subjects. 562 subjects were reviewed, 159 (29%) of which have no information about teaching strategies or evaluation. Moreover, some programs record the same teaching and assessment strategies for all subjects in the program, 45 (8%).

Table 2 presents the results by subcategory and the total presence of RACT in the different groups of subjects, basic area or foundation subjects (which introduce and contextualize the student in the field of knowledge), Research, Humanities (the study of the behavior, conditions and performance of the human being), disciplinary professional area (gives the basic grammar of the profession and discipline) and those of the flexible area (the student chooses them according to personal interests, allow to the learner to approach, contextualize and study in depth aspects of the profession and discipline, allowing to learn tools and other kinds of knowledge, leading to develop interdisciplinarity, flexibility and diversity).

The information provided makes it possible to indicate RACT as a subject: Workshop of Critical Thinking and Introduction to CT ; second, as a subject content: CT in Nursing, and, third, RACT is evidenced in teaching-learning strategies.

The highest percentage of subjects in which RACT is evident correspond to the area of humanities, with 46% (55), in which analysis of real situations, group work, concept maps, role playing and seminars are predominant.

In second place, it is in the professional-disciplinary area with 42% (307) subjects with the predominance of the following strategies: supervised clinical practice, clinical case, problem-based learning, simulation laboratories, and the nursing process. The research is in the same place, 42% (41) subjects. The most commonly used strategies are: critical discussions of research reports and articles, project development, workshops, and problem-based learning.

In the last place, subjects from the basic or foundation area 144 (24%). Including discussion workshops, concept maps and case studies.

A great variety of strategies have been identified, among them are: presentation and discussion of clinical case, group work, clinical practice, flipchart, observation guides, debates, discussion about specific topics, resolution of case studies, support of the nursing care plan, investigative reports , workshop development.

What is evaluated: the development of competencies, the acquisition of skills, the development of superior cognitive processes, the professional spirit and the development of processes and independence.

Finally, in some of the subjects, the intentionality of the evaluation of the RACT is explicitly presented: written works about the topics of each seminar in which the proper handling of the bibliography is evidenced, the capacity for criticism, analysis and synthesis, evidence of problem solving, case analysis and Nursing Based in Evidences , didactic relationship analysis and fundamental elements of the RACT, conceptual knowledge, written and oral reflections, group work, practical reflections and group discussions.

It is evident that traditional evaluation techniques still exist: evaluating procedural aspects, dexterity, motivation and initiative in the procedures, memory evaluation, participation in class, oral and written interventions and, finally, the replication of the topics studied in classes.

Therefore, the analyzed programs show interest in including as an important element in their future graduates the development of the RACT. This aspect is vanishing in the development of the subjects. It is evident in the pedagogical strategies, but it is lost until disappearing in most of the evaluative processes.

The analysis results of the plans and programs of the HEI and HEIN allow to conclude that the proposes of the Law of Higher Education to develop the RACT in the students does not guarantee that it is included in the subjects and evaluations.

What is stated in HEI and HEIN allows us to infer that epistemological and theoretical contradictions are present in the Institutions and among them. It makes necessary an epistemological, theoretical and methodological consideration in order to achieve alignment and coherence between the purposes in the curricular guidelines and what is programmed in the curricular plans for the concrete work with the students. This matter goes against comprehensive training, since it is demonstrated that critical and reflective skills contribute to train professionals with greater ability to care for patients ( 23 ) .

It should be noted that it is the University or HEI that determines the philosophical bases that will guide the academic units that compose it, so that they, in turn, incorporate these principles into their academic programs. The results show that there is no linearity between the proposals of the university with respect to its mission, vision, objectives, graduation profile, curricular guidelines, and what is proposed in the nursing degree programs. There is more linearity in Institutions with a longer trajectory and development, private and public ones.

The analysis of the areas in which the subjects are grouped made it possible to identify that the subjects of the humanities area have the highest percentage of presence of the RACT. This result can be explained by the strategies used, but even more by the subjects under study, since it has been demonstrated that the teaching-learning strategies based on the humanities have a significant impact on the development of skills such as clinical reasoning ( 24 ) . The subjects in the professional area use strategies such as case study, supervised clinical practice and other relatively new ones as problem-based learning and simulation laboratories. Strategies that, by involving simulation or potential practical actions, contribute to enhance critical skills and make decisions that lead to the future professional committing fewer errors during the care of patients ( 25 - 26 ) .

By contrast, it is not the same with the subjects of the foundation or basic area in which it is necessary to return to some knowledge aspects that already exists, such as anatomy, physiology, anthropology, psychology, statistics, among many others. For some students these topics are very difficult and involve, on several occasions, an excellent dose of memory. However, the teaching strategies that develop the RACT are not so frequent. It is important doing more research on this point to sustain if it is true.

On the other hand, for the majority of HEIN, training is conceived as qualification and progress achieved by people and as a principle of theories, concepts, methods, models, strategies and courses of pedagogical action that aim to understand and qualify the teaching. In some cases, the transfer of knowledge is approached, but it still underlies the concept of learning as acquisition of knowledge built and finished; the teacher is the one who has the knowledge and the student is who learns what teacher knows.

The curricula of the Andean region include explicit elements that contribute to the development of the RACT, such as reading, writing and reasoning, allowing to the future professional to know how to learn, reason, think creatively, generate and evaluate ideas, make decisions and solve problems ( 24 ) . It includes as proposals the development of social skills, with emphasis on oral and written communication, cognitive skills including problem solving, establish different alternatives, understand the consequences of actions, make decisions and critical thinking ( 16 ) . Also, intend to achieve in the student some characteristics of the critical thinker like to be creative, innovative, proactive, analytical, participatory, entrepreneurial, self-critical, supportive, humanistic, ethical and scientific ( 27 ) .

Regarding the pedagogical models proposed by the HEIN, inconsistencies between the approach of constructivist approach and meaningful learning are evident. The axis is the student and the repetitive approach in the subjects with master class methodology, reading guides and analysis made by teacher, but not by the student. It shows a traditional model centered on the teacher, with an emphasis on memory, comprehension and the application of concepts. Some subjects focus learning on the acquisition of concepts, despite using the integrating project as a teaching-learning strategy, workshops and practice as evaluation. The pretense for the development of the RACT is not in line with the evaluation, with the examination, in the application of contents, since it is centralized in aspects of memory and knowledge, in an asymmetric theory-practice relationship.

Although significant learning is intended and the importance of integrating it into the formation of learning approaches with the intention of promoting critical thinking, added with successful learning experiences ( 28 ) , it is not really concrete how it could be achieved. Strategies such as simple repetition and teaching for the acquisition of concepts show the persistence of the traditional educational models.

This study found there is no a clear structure to operationalize the theories of the proposed pedagogical models, even though there are expressions that point to RACT. Thus, the elements important for its development are presented in the teaching and learning strategies in a more remarkable way.

The curricular guidelines express the intention to transcend technical rationality and behavioral objectives ( 29 ) , from the positivist, rationalist or empirical analyst paradigm, to the humanist and critical curriculum ( 30 ) to the socio-critical paradigm and critical thinking based on hermeneutic processes ( 31 ) . The social and contextual (political, economic and cultural) aspects that influence and determine the health behaviors of the people are still incipient in the curricula ( 32 ) .

According to what has been demonstrated, it is possible to state that there is no predominance of a pedagogical model, but a mixture of several models in the same program with varied influences. The presence of the following models was identified: Traditional Pedagogical, Behavioral, Cognitive, and Social Pedagogical, the latter being very tenuous ( 33 ) .

There are four fundamental elements to forming critical thinkers: first, the question; second, the creation of continuous opportunities to participate in dialogue, debate, research, and critique; third, self-evaluation and hetero-evaluation; and fourth, teachers as models of critical thinkers ( 32 ) . Considering these elements, we can assure that the creation of opportunities is present with more intensity in some curricula, and self-evaluation and hetero-evaluation have begun to be implemented especially in public institutions.

Mentioning the subjects, it is not evident that the thought is motivated by complex kind of questions that encourage exploration, generate evaluation, create concepts and knowledge ( 33 ) .

The literature points out that the Socratic questions stimulate the student to use existing knowledge, since they promote a greater understanding and integration of new knowledge, they foment the habit of thinking critically ( 8 , 34 ) . Other authors suggest, for the reports, questions about the purpose, information, concepts, assumptions, implications, points of view and the questions, as elements that favor analysis, the evaluation of ideas and reasoning ( 24 , 35 ) .

Like other researches, this study found that the most used strategies in the progress of the professional area that promote the development of RACT are the case study ( 24 , 36 ) , problem-based learning ( 24 ) , supervised clinical practice ( 37 ) , the nursing process ( 4 , 38 ) and simulation laboratories ( 34 , 37 - 38 ) . In this article, we only refer to two of these strategies, which were selected because of the great advance of information and communications technologies. The growing need to access this kind of infrastructure as a fundamental part in the training of future professionals and as an example of a single teaching and learning strategy is not sufficient to achieve the RACT, rather, the use of different techniques enhance its development, as we will see below.

We agree with the conclusion of authors who suggest that Problem-Based Learning and simulation labs are active strategies that develop RACT in nursing students ( 37 ) .

The case study, moreover, promotes active learning, helps to solve clinical problems, promotes the development of critical thinking skills ( 34 - 35 ) , in addition, it allows to integrate knowledge, to think as a professional, to analyze individual situations in specific contexts from different angles, to use theoretical concepts in the delimitation of a concrete problem ( 36 ) . It also stimulates collaborative and team work, the work with different points of view. The question-problem is the motivator in the search for alternative solutions, is useful in simple and complex situations, allows to apply theory in practice, promotes the exchange of ideas, teaches students to learn to control their own thinking and promote the exchange of ideas and intellect ( 37 ) . In addition, it helps to incorporate time management and take responsibility. It also facilitates the integration of the four elements of the Nursing metaparadigm: the person receiving the care, health as purpose, the nature of the nursing and the context or environment.

The case study allows the simultaneous implementation of other strategies that further enhance the development of RACT, such as concept maps, the analysis and selection of scientific evidence, the nursing process, nursing history, role-playing, argued discussion and debate.

In contradiction to all the positive aspects of the case study in the development of RACT, the dichotomy between theory and practice in a large number of the curricula reviewed is an obstacle to achieving all the benefits pointed out. Since some teachers are in charge of the development of the theoretical subject in the classroom, others are in charge of their practical part in other spaces that require this care.

Regarding the practice based on simulation models, a study ( 38 ) shows how the promotion of RACT is relevant. In this connection, it highlights the importance of including simulation as a key element in curricula, because it ensures skills in this kind of thinking ( 38 ) and gives students the opportunity to show their ability in decision-making, critical thinking and other skills ( 39 ) . Other authors emphasize its importance when students reflect it on their thinking process and show how it guided their actions ( 34 ) .

There is efficiency of simulation laboratories when accompanied by active strategies, such as the conceptual map before each laboratory session, a visual aid that allows the concepts, objectives, justification, expected results and possible complications to be described in a logical manner if the procedure is not carried out in the appropriate manner ( 34 ) . The same author suggests the use of high-level questions to stimulate reason more than memory. He also suggests assigning an observer, who will ensure analysis and reflection on patient safety, communication, teamwork and leadership, among others ( 34 ) . The reflection of the group around the whole process carried out will be the end of the laboratory ( 15 , 34 ) .

Another study concluded that simulation as a pedagogical method allows students to recognize, interpret and integrate new information with previous knowledge in order to make decisions about the best direction to follow. The authors state that simulation, as an educational method, provides an opportunity to systematically structure learning to help students acquire deep content knowledge and to facilitate the development of thought processes; that simulation experiences stimulate students’ RACT skills and help them become more competent in caring for patients in complex conditions ( 37 ) .

We agree with what has been found in other studies emphasizing that simulation laboratories by themselves do not guarantee the development of RACT skills, but if combined with other strategies and implemented with adequate pedagogy, the results will be much more effective in terms of CT skills ( 34 , 37 - 38 ) .

It is also possible to find correspondence with that was discovered in the State of the Art of scientific production in RACT in the Andean region. The students perceive that “Clinical simulation is a valuable strategy for the acquisition, complementation and integration of the theoretical part with the practical part, because it seeks to make decisions according to the CT” ( 38 ) .

The evaluation of the subjects is cumulative and formative. In some cases, a diagnosis of the level of the student’s participation in the subject is made; it is evaluated in the intermediate and at the end with the objective of promotion to another level. In other cases, a teaching-learning balance is done to verify the fulfillment of the objectives and competences. Self-evaluation and heteroevaluation are increasingly used, implying a process of reflection, analysis and self-criticism.

Precisely, evaluation appears as one of the weakest points when analyzing the presence of RACT in curricula. Therefore, we agree that the “best teaching practice begins by establishing learning outcomes and continues with a focus on helping the student to achieve satisfactory results”. If the proposal is to achieve a higher order thinking, the evaluation will be oriented towards the synthesis, analysis and evaluation of knowledge ( 40 ) .

Overall, the strong approaches to RACT training formulated at HEI, HEIN, as evidenced by some of the teaching and learning strategies presented in the subjects, become much weaker in the evaluation process, with predominance of traditional evaluation models, and in some cases, the intention to evaluate RACT is outlined.

The curricula of Colleges and Schools of Nursing in the Andean region explicitly contemplate reflective and critical thinking in their mission, vision, objectives, graduation profile and didactic strategies, and implicitly as integral formation. However, there is a tension between what is proposed by the HEI and HEIN and what is implemented and evaluated in the subjects. The presence of RACT in the proposed didactic strategies is much more evident, but it is not sufficiently objective or explicit in the evaluation processes.

Despite the great diversity of pedagogical models, there is a clear intention to facilitate the development of RACT. In addition, although a constructivist model is proposed centered on the student, dialogical, active, reflexive, innovative and critical, this model is more centered on the teacher than on the student; on knowledge over a relationship between equals; more on results than on the learning process. Likewise, knowledge is considered as something finished, fixed and the ultimate truth.

In order to be able to teach the RACT to the nursing student it is necessary to include it in the nursing curriculum, teachers who are professionals in the areas of Education and Nursing and with RACT in their training. Teachers should create spaces for the development of RACT, know and implement the different and complementary didactic strategies that facilitate its learning and that analyze the students in relation to the level of RACT achieved.

The authors of this article suggest that the projects currently developed with teachers and students in Ibero-America should be finalized and retaken with the implementation and evaluation of strategies that value the development of RACT.

RACT is considered an indispensable element in personal and professional development, in order to have autonomy, confidence, the ability to make decisions, reach clinical judgment and, the most important, provide individualized, comprehensive and human nursing care. In summary, graduates should be able to work as members of the health team with sufficient clarity of the role and identity they should have, because they have to integrate and experience the four paradigms of the Nursing.

The limitations of the study are

The complexity of the project due to the number of participating countries and the different research groups;

The large number of public and private nursing schools and colleges in the Andean region;

The limitation in accessibility to the complete information of the curricula of each institution;

The minimal presence of information on the official web pages of each institution, school or nursing college;

No response and lack of interest from different schools and nursing colleges, public and private, to participate of this project;

Limited access of current and recent updates of the curricula of nursing colleges to develop this project.

The research group made efforts to reduce these limitations and devised multiple options that were proposed to the institutions, in order to facilitate the provision of information and its complementation when necessary.

Applications for practice

The innovation and contributions expected with this research are based fundamentally on documenting and analyzing of the diverse existing evidences about if RACT is contemplated in the nursing curricula or not, the strategies used by teachers to create and promote it in nursing students and the evaluation processes employed. It provides insights about how RACT’s competence in nursing is addressed in the context of the Andean region and other regions of Ibero-America, its weaknesses and strengths, as well as the improvements that can be made. The final intention of the research is to offer, as a network and collegial body, proposals for teaching, learning and evaluation that will enable the empowerment of new generations of nurses, using RACT as a center of innovation and development.

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Teaching Students About Systems Thinking

These strategies guide students to explore the interconnected parts of complex systems like the human body, governments, and ecosystems.

Illustrated blocks

Our world is interconnected and complex. As a result, our students need to move beyond fragmented ways of thinking, which look at problems in isolation or focus on short-term solutions. By developing our students to be systems thinkers, we can enable them to see patterns and organize their learning both inside and outside of school.

Let’s break this idea down by first describing what we mean by a system. Generally speaking, a system is a group of interconnected elements that are organized for a function or a purpose. System elements, or parts, may be physical or intangible things.

Importantly, system parts are interdependent. A change in one element can produce change within the entire system. This means systems are nonlinear. When consequences occur, they’re not isolated. They ripple through a system. Systems we encounter daily include the human body, cities, governments, social networks, and the Earth’s climate.

To give a narrative example, in Dr. Seuss’s well-known book The Lorax , the parts of the system are things like the water, air, Truffula Fruits, Brown Bar-ba-loots, and Humming-Fish, as well as the Once-ler’s greed and desire for economic growth above all else. Imagine if the Once-ler had truly understood how his behaviors impacted the Truffula Tree ecosystem, including the sustainability of his own Thneed production. His inability to think holistically led not only to a range of negative environmental consequences, but also to the collapse of his own business. 

In a global issue such as plastic pollution, system parts may include crude oil production, plastic manufacturing, companies, consumers, wastewater, and greenhouse gas emissions.

Systems thinking helps students manage complexity

Systems thinking is a mindset as well as a set of tools that enables students to recognize and understand relationships and interconnectedness. It’s an ability to toggle between the parts and the whole of a system to understand how interactions produce negative or positive behaviors. 

Systems thinking supports our students to understand the complexity of the world and manage its uncertainty, especially in a time of increased globalization; it is an essential component of critical thinking that teachers can apply across the curriculum. For example, using systems thinking, students can do the following:

  • Chart character development in a piece of literature with behavior-over-time graphs
  • Map nonlinear causes and consequences of historical or political conflicts
  • Understand the relationships between parts of a cell, as well as between cells, organs, and body systems
  • Analyze and take action on real-world issues, such as global warming, poverty, or overfishing

Teachers, curriculum coordinators, and school leaders can also use systems thinking tools, such as Agency by Design’s Mapping Systems protocol , to better understand the way parts of our educational system connect to produce positive or negative outcomes for students, such as lower attendance, higher referrals to learning interventions, or increased mental health issues.   

Fostering systems thinking as critical thinking

There are a number of ways teachers can facilitate systems thinking in the classroom. By slightly shifting how we interact with students—our questions or thinking prompts—we can promote “thinking in systems.”

Question with intention: Knowing we want to move away from “A leads to B” linear thinking, we can intentionally ask questions that encourage students to reflect on multiple parts of a system and how they connect. Instead of asking, “What caused this?” which communicates that there is a single cause, we can instead ask, “What factors contributed to this?” allowing students to search for multiple causes and nonlinear relationships.

Take a helicopter view: Toggling between the details and the big picture is an important systems thinking skill and one of the habits of a systems thinker . When looking at a situation, event, or particular issue, encourage students to discuss systems as a whole. For example, in the classroom we may create a circle, where each student represents a system part and makes connections with a ball of string. Students name how they connect to another system part as they toss the ball of string to one another, with each student retaining some of the string as they pass the ball around. At the end, students can see the interconnectedness of parts by gently tugging on the yarn and seeing who is affected.

Encourage pattern recognition: We want students to see the web of interconnections within systems and recognize how systems connect to other systems. During the Covid-19 pandemic, for instance, we saw how health systems impacted transportation and the economy, leading to certain goods being unavailable. By asking, “What’s this got to do with that?” we nudge students to go both deep and wide in an investigation.

Strategies for Teaching systems thinking

Many strategies for systems thinking encourage students to visualize and create “system pictures.” Because of the high degree of interaction within systems, many strategies invite students to map connections in nonlinear ways. Here are some concrete strategies we can use in the classroom.

Connected circles: In this strategy, a circle represents a particular system, and the parts of the system are written around the outside. Using a case study such as an article, video, or real-life experience, students chart connections across the parts of the circle, writing the relationship between parts on the connector line. A connected circles template can be modified for any system that students will explore.

Systems models: After researching a system such as a tropical rainforest or coral reef, students create a systems model using divergent physical materials, e.g. Lego, magnetic tiles, wooden blocks, paper, cotton balls, shells, stones, etc. After making representations of the system and its parts, students annotate the model with sticky notes, arrows, etc. to show relationships between them. This may also include inputs and outputs of the system. For example, sunlight and carbon dioxide go into the rainforest (inputs), and oxygen and water vapor come out (outputs).

Games and simulations: Matthew Farber has written extensively about the use of constructionist gaming to promote thinking about complex systems. He shows how making and thinking come together to allow students to play with systems. The Joan Ganz Cooney Center at Sesame Workshop also writes about the role of digital learning to promote understanding of systemic causes in young children. 

By inviting students to play with and explore systems thinking tools, we enable them to see structures and patterns within and across the content areas. Such engagements can empower students to find solutions to local, global, and intercultural issues that may have previously seemed unsolvable.

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Russia’s limits on critical thinking are hitting its academic performance

Stricter political and administrative controls on what can be said have led to the creation of a pioneering ‘free university’, say katarzyna kaczmarska and dmitry dubrovsky.

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Recent months have seen heated debates in Russia about the limits of faculty and students’ rights to undertake public speaking and engage in political activism.

Lecturers at the prestigious  Higher School of Economics  (HSE), once considered Russia’s most liberal university, have spent the summer worrying that their criticisms of the political status quo might put an end to their teaching careers.

A master’s programme was apparently shut down when the university’s management realised that Yegor Zhukov – a prominent blogger and participant in the 2019 protests against fraudulent practices in the elections for the Moscow city parliament – was among the newly admitted cohort. He was also badly  beaten  just hours after he posted a video on YouTube explaining that he had been enrolled and then, less than two hours later, was crossed off a list of students admitted.

It has proved contentious for scholars to speak out in public and for students to engage in political activity at least since the 2019 protests. Zhukov was an undergraduate at the HSE when he was  arrested  following an unsanctioned opposition rally that summer. This led many fellow students, staff and alumni to express solidarity. However, though the management initially supported calls for Zhukov’s release, it later shifted to a policy seemingly designed to avoid future clashes with the state authorities.

In 2020, the university introduced new  internal regulations  requiring staff and students to refrain from using their university affiliations in public statements that could trigger “negative social reactions and/or have negative reputational consequences for the university”. Though these regulations are careful to emphasise that there are no restrictions on academics speaking out about their “research results” and matters of “professional competence”, keeping within the guidelines is likely to be difficult, particularly for those researching current social or political developments in Russia. This attempt to establish a boundary between “legitimate” academic research and “unacceptable” participation in public debate amounts to another way of silencing critically minded scholars.

After the journalist Svetlana Prokopyeva was  found guilty  in July of “justifying terrorism” when she dared to ask about the connection between the repressive political regime in Russia and a suicide bomb outside the Federal Security Service office in Arkhangelsk, several HSE employees produced a paper citing values such as “academic ethics” to delegitimise debate about terrorism and its causes. A few scholars  responded  by pointing out that such a stance could close down research into social phenomena such as terrorism, state terror, revolution and liberation movements.

The HSE has also decided not to extend the contracts of a number of academics for the coming academic year. Though the university’s management has defended its decision on grounds of efficiency and necessary restructuring, those adversely affected argue that the dismissals were motivated by an urge to get rid of those who were most  outspoken  and critical of the political system in Russia, including the abruptly amended  constitution .

The British Association for Slavonic and East European Studies (BASEES) published a  letter  this July in which the president shared his unease “about the integrity of the process by which decisions over continuing employment and terminations of contracts are taken” and emphasised that these developments undermine the HSE’s position as a close partner for scholars and universities in the UK. And Russia’s  University Solidarity  trade union  called for  a protest (using a hashtag translating as “you can’t shut us up”) against measures to punish scholars and students for their outspokenness.

Then, in late August, a group of scholars, including those whose contracts at HSE have not been renewed, issued a  manifesto  announcing the establishment of Russia’s first Free University and stating that one of their main goals is to free lecturers from excessive administrative pressures (among which they mean to include the pressure not to speak out).

Among the group is Gasan Guseynov, whose social media post last year criticising abuses of the Russian language by journalists and politicians  prompted  HSE management to look into whether it “violated academic ethics in public speaking”. This led to a committee’s  recommending  that Guseynov make a public apology for the “deliberate dissemination of ill-considered and irresponsible statements that have caused damage to the university’s reputation”.

All of this took place against a background of Russian universities failing to achieve the planned leap in international rankings; more and more insecure  employment contracts ; and  legislation  requiring that education in schools and universities should include not only knowledge and skills, but also spiritual and moral values.

A recent  analysis  of the obstacles to scientific progress in Russia concludes that research managers do not prioritise the creation of the kind of new scientific knowledge likely to be recognised by the international academic community. This study was authored by people close to Alexei Kudrin, who represents the liberal-leaning wing within the ruling elite.

What even this group fails to mention, however, is that the problem does not reside so much in management structures as in a political system that crushes creativity and punishes critical thinking and activism.

Katarzyna Kaczmarska is lecturer in politics and international relations at the University of Edinburgh . Dmitry Dubrovsky is an associate research fellow at the Centre for Independent Social Research  in Russia.

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25 Best Universities In Moscow For International Students 2024

Moscow is surely one of the places you should be considering if you’re looking to study in Russia . This location has a lot to offer for international students, including world-class universities and exciting student experiences. With more than 59 universities and colleges in Moscow, you’ll surely have a wide range of choices.

Out of 59 universities in Moscow , RUDN University and Moscow State University are the top-performing schools in Moscow. This list covers both public and private institutions in Moscow.

To help you narrow down your school options, we’ve compiled the best universities in Moscow. We based our rankings on academic reputations from reputable sources and the number of international students. By doing this, you’ll have an efficient way of comparing your target universities and choose your host university in Moscow.

How do I get admission to the best universities in Moscow?

Applying to the universities in Moscow involves submitting requirements and following specific admissions procedures set by your chosen university. The requirements often include a student visa, application packages, and language scores. Check out our guide for international students who want to study in Moscow to learn more about applying for admission in this country’s universities!

How much are the tuition fees at the best universities in Moscow?

Tuition fees at Moscow’s universities can vary depending on which university, degree, and program you will be enrolling in. Generally, tuition fees for the bachelor’s level range from 0 RUB to 730,000 RUB , while tuition fees for the master’s level range from 0 RUB to 870,000 RUB. If you are interested, check out the affordable universities in Moscow !

As we cover the best universities in Moscow for international students, feel free to check out the university’s information on Admission, Tuition, Courses, and Language Requirements by looking at the individual university pages.

Top Universities in Moscow for International Students

1 rudn university.

RUDN University is one of the best universities in the capital city of Russia and is known as The People’s Friendship University of Russia. This higher education institution is mostly known for the high number of international students attracted to this university’s high ranking. The university is ranked among the world’s top 500 universities, which speaks volumes about the level of study this university provides.

2 Moscow State University

Moscow State University is one of the largest public universities in Moscow, Russia. This university is the cornerstone of formal higher education, and it provides education to close to 40,000 students. Some of the most attended programs are in the fields of economics, politics, and finance, where students gain real-world experience that may help them in their careers.

3 National Research Nuclear University MEPhI

The National Research Nuclear University MEPhI is one of the world’s most prestigious universities in its field and the perfect place for candidates that would like to specialize in nuclear technology. It focuses on fostering innovation, creativity, and internationalization. The university is known for its wide and highly specialized degree offer and its outstanding research performance. It has multiple institutes that develop studies in areas like nanoengineering, cyber-physical systems, and plasma technologies. These projects are completed in state-of-the-art facilities that include a research nuclear reactor and an accelerator.

4 National Research University Higher School of Economics

The National Research University Higher School of Economics, or otherwise known as HSE University, is one of the best universities of higher education in the capital city of Russia. This institution has one of the largest campuses in the country that houses approximately 50,000 students and can provide them with all the necessary equipment for them to have the best possible experience.

5 National University of Science and Technology MISIS

The National University of Science and Technology MISIS started as a mining academy and then became a steel institute. Over time, it expanded its course offer and modernized its facilities, but it’s still widely known for its programs in metallurgy and mining. Nowadays, the university has six campuses, 8 academic colleges, and multiple research institutes. They also have cutting-edge specialized laboratories in fields such as nanomaterials, cryoelectronic systems, biophysics, casting technologies, and much more!

6 I.M. Sechenov First Moscow State Medical University

I.M. Sechenov First Moscow State Medical University or usually referred to as Sechenov University was founded in 1758, making it the oldest medical school in Russia. It was initially the medical faculty of the Imperial Moscow University and eventually became independent in 1930. At present, the university has more than 18,000 total enrollment and offers undergraduate to Ph.D. programs in Medicine, Sciences, and Professional Education.

7 Plekhanov Russian University of Economics

The Plekhanov Russian University of Economics is a public university with over a century’s history of world-class economics and management education. Programs at the university are strongly focused on practical learning and provide opportunities for students to gain professional and international experience with its numerous partner employers around the world. The university also conducts several initiatives and projects that aim to address different educational, industrial, and social issues. 

8 Russian Presidential Academy of National Economy and Public Administration

The Russian Presidential Academy of National Economy and Public Administration is a very young institution of higher education located in the capital city of Russia. This university has grown in popularity in the region, and it now has over 46,000 students studying in various fields. Despite its youth, this university is ranked among the top 801 universities in the world by the prestigious QS World University Rankings.

9 Bauman University

Bauman University is one of the oldest and most prestigious universities in Russia. It specializes in education and research in applied sciences and engineering. The university boasts excellent programs for all levels of higher education and is home to some of the most advanced scientific laboratories and facilities in the country.

10 Financial University under the Government of the Russian Federation

Ranked among the best universities in Russia and the world, the Financial University under the Government of the Russian Federation is a specialized institution that aims at contributing to the country’s economic development and financial transformation. This is a prestigious university known for being the educational home of many important Russian figures including prominent politicians, millionaires, and CEOs of important companies. It focuses on providing hands-on learning and encouraging critical thinking by using methods like case studies, discussions, and financial projects. It also has partnerships with governmental bodies and major businesses in order to offer workshops, academic collaborations, and internship opportunities.

11 N.R.U. Moscow Power Engineering Institute

N.R.U. Moscow Power Engineering Institute is a public technical university in Moscow with a prominent reputation for producing outstanding scientists and engineers for more than 90. It is also one of the most sought-after universities for aspiring engineers from around the world. The university also has numerous cooperation agreements with foreign universities and companies for its students and faculty to participate in different international programs and activities. 

12 Moscow State Pedagogical University

Moscow State Pedagogical University is a Russian higher education institute that offers Bachelor’s, Master’s, and Doctoral programs. It was established as the Women’s Courses of Higher Education in 1872 and underwent a transformative journey to what it is now. The university is well-recognized with International Partners across the globe, such as the University College of Teacher Education Vienna in Austria, the University of Pardubice in the Czech Republic, and the CY Cergy Paris University in France. Accessibility is a forefront advocacy with dedicated institutes for it, such as the Center for Student Disability Services and Psychological Assistance Center.

13 Mendeleev University of Chemical Technology of Russia

The Mendeleev University of Chemical Technology of Russia is the largest institution that offers education, training, and research in chemical technology in the country. The university was established in 1898 and is dedicated to raising future engineers and specialists who can formulate solutions to the most pressing scientific, industrial, and societal problems. It is also the alma mater of several notable individuals with significant contributions to different branches of science and chemistry.  

14 Russian National Research Medical University

Pirogov Russian National Research Medical University (RSMU) is a private university specializing in medicine located in Moscow, Russia. It was founded in 1906 as the Higher Medical Course for Women. Among the programs available at the university are general medicine, pediatrics, biochemistry, dentistry, pharmacy, social work, psychology, neuroscience, and radiology.

15 Moscow State Institute of International Relations

The Moscow State Institute of International Relations is one of the most prestigious and elite universities in Russia and the world, making it the perfect place for studying anything related to diplomacy, economics, international affairs, or languages. This institution strives for internationalization, which is why it has partnerships with multiple universities worldwide with which it offers dozens of double and triple degrees. It has different research institutes that develop studies in diplomacy, governance, energy policy, and global matters. Additionally, it constantly collaborates with international organizations and local governmental bodies.

16 Moscow Aviation Institute

Moscow Aviation Institute is an aviation school that offers Bachelor’s, Master’s, and Postgraduate level programs. Both the Russian and English languages are used as mediums of instruction. Aside from these university programs, Pre-university and Professional training programs are also offered. Nine dormitory options filled with quality service facilities are present for student residents. Three Metro stations are also near the campus, providing sufficient access for students with no personal vehicles.

17 Gubkin Russian State University of Oil and Gas

The Gubkin Russian State University of Oil and Gas is a specialized institution of higher education. This institution mostly focuses on developments in the field of oil and gas extraction and the safety of this direction. The main attraction for students is the affordable tuition prices for top-of-the-crop programs that are taught by experts in the relevant fields.

18 Russian State Social University

The Russian State Social University is a distinguished university in the country of Russia because it provides all levels of study to both domestic and international students with the opportunity to gain various financial aid through university or state-funded scholarships. This university is located in Moscow and was founded in 1991, but it is making its way slowly toward the ranking of the best universities in Russia.

19 Moscow Polytechnic University

Established in 1865, Moscow Polytechnic University, or Moscow Poly, is one of Russia’s educational institutions that provide technology-related programs. Currently, they deliver education to more than 16,000 local and international students. As they provide top-quality education and research in various fields, they also have various activities on campus to foster diversity.

20 Synergy University

Synergy University was established in 1988 and is one of the top business schools in Russia. The university’s programs are focused on providing strong fundamental knowledge of different principles, theories, and concepts and combining it with experiential learning to develop its students’ skill sets, thereby preparing them for the professional world. Synergy University has a student population of over 65,000 and has international campuses and branches in Dubai, London, United Arab Emirates, and New York.

21 National Research University of Electronic Technology

The National Research University of Electronic Technology is a public university that offers undergraduate and graduate-level education. In total, there are 40 Bachelor’s programs and 42 Master’s programs. It was founded in 1965 and was only officially renamed to its current title in 2011. Annual enrolment is estimated to be 4500 students, and over 600 academic staff are present to handle them. Not only do other universities partner with the National Research University of Electronic Technology, but over 131 corporations also cooperate with it.

22 Russian State University of Physical Culture, Sport and Tourism

Russian State University of Physical Culture, Sport, and Tourism is a leading sports university in Russia. It was established in 1918 and is known for producing over 200 outstanding athletes that have made their marks in prestigious international competitions such as the Olympics. The academic and research programs at the university are conducted by highly qualified and reputable coaches, experts, and scientists to further enhance athlete training and prepare future sports champions and professionals. 

23 Moscow City Teachers’ Training University

Moscow City Teachers’ Training University is a public university in Moscow, Russia. The Ministry of Education established it in 1995 as a pedagogical university, with only 1300 students in its first year. The university currently has over 18,000 students and offers degree programs in the humanities, natural sciences, sports technology, law, business, and language studies.

24 New Economic School

The New Economic School (NES) is a private institution located in Moscow that focuses on teaching and research in the field of economics. It takes pride in having a faculty made up of established professionals from the field, most of them holding a Ph.D. NES aims to train students who will be able to make valuable contributions to the growth of Russian society and business.

25 State University of Management

The State University of Management has been a frontrunner in providing management education in Russia for over 100 years. The university offers practice-oriented management education and training in different specializations such as business informatics, hotel management, and advertising. The State University of Management also conducts intensive research and innovative projects aimed at improving its academic programs and responding to the needs of the country’s economy. 

We know that choosing your dream school in Moscow not an easy task. After all, you need to consider other factors like the cost of your education, school background, and population, as it can be overwhelming on your part.

So, to help you out further in weighing your school options for studying in Moscow , make sure to visit our list of the best public and private universities in Moscow! These articles will surely help you in deciding your next study destination!

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  1. Critical Thinking as a Nurse

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  2. The Nursing Process And Critical Thinking (Step by Step)

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  3. 5 Steps to Improve Critical Thinking in Nursing

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  5. Chapter 2 Critical thinking and Nursing Process Diagram

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  6. Why Critical Thinking Is Important in Nursing

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  1. "Nursing Research & It's Implications"

  2. NURSING PROCESS PART 1 critical thinking in nursing

  3. CRITICAL THINKING IN NURSING PROCESS

  4. Chapter 2: Critical Thinking

COMMENTS

  1. Critical Thinking in Nursing: Developing Effective Skills

    Critical thinking in nursing is invaluable for safe, effective, patient-centered care. You can successfully navigate challenges in the ever-changing health care environment by continually developing and applying these skills. Images sourced from Getty Images. Critical thinking in nursing is essential to providing high-quality patient care.

  2. The Value of Critical Thinking in Nursing

    Critical thinking in nursing protects patient health and contributes to professional development and career advancement. ... 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 ...

  3. What is Critical Thinking in Nursing? (Explained W/ Examples)

    Critical thinking in nursing is the foundation that underpins safe, effective, and patient-centered care. Critical thinking skills empower nurses to navigate the complexities of their profession while consistently providing high-quality care to diverse patient populations.

  4. Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and

    Critical Thinking. Nursing education has emphasized critical thinking as an essential nursing skill for more than 50 years. 1 The definitions of critical thinking have evolved over the years. There are several key definitions for critical thinking to consider. ... Foundation for Critical Thinking; 1993. 10. Benner P, Tanner C, Chesla C ...

  5. Use of Foundational Knowledge as a Basis to Facilitate Critical

    Critical thinking frequently involves the ability to interpret information and make informed decisions based on such information, which usually includes foundational knowledge. There is a need in nursing practice for graduates with critical thinking skills to enable them to make informed clinical decisions that will benefit patients.

  6. Critical Thinking: The Development of an Essential Skill for Nursing

    Critical thinking is applied by nurses in the process of solving problems of patients and decision-making process with creativity to enhance the effect. It is an essential process for a safe, efficient and skillful nursing intervention. Critical thinking according to Scriven and Paul is the mental active process and subtle perception, analysis ...

  7. Critical thinking in nursing clinical practice, education and research

    Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing ...

  8. Critical thinking in nursing clinical practice, education and research

    Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student ...

  9. Laying the Foundation for Critical Thinking With the Nursing Taboo Game

    Introduction. Upon graduation from prelicensure programs, baccalaureate-prepared nurses are expected to be able to "use clinical/critical reasoning to address simple to complex situations" (American Association of Colleges of Nursing, 2008, p. 8).However, before critical thinking can be employed, one must first have a solid foundation in nursing knowledge.

  10. Critical Thinking in Nursing

    Critical Thinking Indicators. From Rosalinda Alfaro-Lefevre (2019), personal critical thinking indicators offer an opportunity to reflect on your current thinking patterns. Engaging and questioning your current practice is a form of self-reflection. Honest and ongoing evaluation of your own progress is a necessity in nursing.

  11. What is Critical Thinking in Nursing? (With Examples, Importance, & How

    The following are examples of attributes of excellent critical thinking skills in nursing. 1. The ability to interpret information: In nursing, the interpretation of patient data is an essential part of critical thinking. Nurses must determine the significance of vital signs, lab values, and data associated with physical assessment.

  12. Using Critical Thinking in Essays and other Assignments

    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 ...

  13. Fundamentals of Nursing

    It's your complete guide to nursing — from basic concepts to essential skills! Fundamentals of Nursing, 9th Edition prepares you to succeed as a nurse by providing a solid foundation in critical thinking, evidence-based practice, nursing theory, and safe clinical care in all settings. With illustrated, step-by-step guidelines, this book makes it easy to learn important skills and procedures.

  14. A Consensus Statement on Critical Thinking in Nursing

    A longitudinal framework for fostering critical thinking and diagnostic reasoning. Journal of Advanced Nursing, 26, 825-832. > Google Scholar; Paul, R. (1992). Critical thinking: What every person needs to survive in a rapidly changing world (rev. 2nd ed.). Santa Rosa, CA: The Foundation for Critical Thinking.

  15. Critical Thinking: Where to Begin

    The Critical Thinking Bookstore . Our online bookstore houses numerous books and teacher's manuals, Thinker's Guides, videos, and other educational materials. Learn From Our Fellows and Scholars. Watch our Event Calendar, which provides an overview of all upcoming conferences and academies hosted by the Foundation for Critical Thinking.

  16. Nursing Fundamentals: Building a Solid Foundation

    Critical Thinking: Nurses must have strong critical thinking skills to assess patient conditions, make sound decisions, and adapt to changing situations. ... Building a Solid Foundation: Key Concepts in Nursing. To provide safe and effective care, registered nurses must have a solid understanding of key concepts in nursing, including anatomy ...

  17. Problem-based learning: A strategy to foster generation Z's critical

    This manuscript will recount the attributes of Generation Z and describe problem-based learning as a strategy to enhance critical thinking and perseverance. Keywords: Generation Z, Problem-based learning, Critical thinking. During the COVID-19 pandemic, the nursing workforce has demonstrated courage and perseverance in the face of challenges.

  18. Critical Thinking Guide

    The ATI Helix of Success is a model developed to illustrate how knowledge and clinical judgment form the basis for nursing practice. It provides you with strategies you can use when answering test items and giving client care. The Critical Thinking Guide presents the essential elements of the ATI Helix of Success. Make a selection to begin ...

  19. Key Competences and New Literacies

    This edited book is a unique comprehensive discussion of 21 st century skills in education in a comparative perspective. It presents investigation on how eight very different countries (China, Canada, England, Finland, Poland, South Korea, the USA and Russia) have attempted to integrate key competences and new literacies into their curricula and balance them with the acquisition of ...

  20. (PDF) Technology "Reading and Writing for Critical Thinking" As a

    The paper presents an analysis of the main ideas underlying the concept of using the technology "Reading and writing for critical thinking" by teachers in order to form some components of the ...

  21. Reflective and critical thinking in nursing curriculum

    76 nursing programs participated in the study. The Reflective and Critical Thinking was found as a subject, subject content and didactic strategies. Of the 562 subjects reviewed, this type of thinking is found in 46% of the humanities area and 42% in the area of research and professional discipline. It is important to train teachers to achieve ...

  22. Teaching K-12 Students About Systems Thinking

    Take a helicopter view: Toggling between the details and the big picture is an important systems thinking skill and one of the habits of a systems thinker.When looking at a situation, event, or particular issue, encourage students to discuss systems as a whole. For example, in the classroom we may create a circle, where each student represents a system part and makes connections with a ball of ...

  23. Russia's limits on critical thinking are hitting its academic

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