Quality and Safety Outcomes in Health Care
Summary of Findings
The rapid review was conducted to establish some of the effective educational strategies that can support critical thinking among undergraduate nursing students. Previous research recognizes the role of critical thinking in promoting the quality and safety outcomes in health care. Various systematic reviews are available on the topic of educational interventions to develop critical thinking in nursing. The current rapid review was based on the identified systematic reviews and a meta-analysis that have relevant information relating to the topic. The interventions are grouped into four categories in the discussion of results, including technological-based strategies, problem-based and evidence-based strategies, teaching strategies, and student-centered strategies.
The reviewed systematic reviews and the meta-analysis investigated the efficacy of technology-based strategies in the development of CT skills. However, only two interventions, interactive videodisc system and interactive videodisc system, were proven effective in improving critical thinking. Interactive videodisc system was found successful in supporting CT skills development in nursing education in the review by Carter, Creedy and Sidebotham, 2016). The appraisal of the interactive videodisc system using CCTDI tool revealed its efficacy (Carter, Creedy & Sidebotham, 2016). Other technology-based interventions were ineffective.
Problem-Based and Evidence-Based Strategies
The systematic reviews and the meta-analysis focused on the problem and evidence-based strategies that promote critical thinking among nursing students. PBL approach was found to be effective when used as an isolated approach in teaching (Carter, Creedy & Sidebotham, 2016; Carvalho et al., 2017; Oliveira, Díaz, Carbogim, Rodrigues & Püschel, 2016). However, it was applied in conjunction with CM since the impact on CT was greater (Carter, Creedy & Sidebotham, 2016; Carvalho et al., 2017). Besides, the strategy could be used with web-based learning to promote CT skills (Oliveira, Díaz, Carbogim, Rodrigues & Püschel, 2016). Carter, Creedy, and Sidebotham (2016) revealed that nursing students could develop critical thinking through the use of evidence-based courses in their learning process.
Some of the reviewed systematic reviews, and the meta-analysis suggested some methods of teaching that could be used to promote critical thinking among nursing students. Educators can use concept mapping in their classrooms to support student learning (Carter, Creedy & Sidebotham, 2016; Carvalho et al., 2017; Garwood, Ahmed & McComb, 2018; Oliveira, Díaz, Carbogim, Rodrigues & Püschel, 2016). However, it would be more useful to use the method alongside others, such as PBL. The use of narrative pedagogy was found to have a positive effect on the development of critical thinking skills in nursing (Carter, Creed, & Sidebotham, 2016). The methods can be used in teaching in isolation or together with others from the various categories.
The results of the four reviews indicated conflicting results regarding the use of simulation. Some suggested that the method is effective in achieving efficacy in teaching CT skills development (Carter, Creedy, and Sidebotham, 2016). However, Oliveira, Díaz, Carbogim, Rodrigues, and Püschel (2016) evaluated the method as ineffective in this area. High-fidelity patient simulation (HFPS) is a specific type of simulation used in teaching nursing students. Reflective writing is one of the student-centered interventions included in the review. Although the method might be useful in developing critical thinking skills, the three studies that evaluated its use did not reveal its efficacy (Carter, Creedy & Sidebotham, 2016; Carvalho et al., 2017; Oliveira, Díaz, Carbogim, Rodrigues & Püschel, 2016). Another student-led method was a reading and writing course, which was revealed as an effective strategy in the development of critical thinking skills.
Strategies that Failed to Prove Efficacy
Some of the interventions did not have any significant effect on teaching critical thinking among nurses. Only Mok, So and Chung (2016) studied the use of High-Fidelity Patient Simulation, but failed to develop statistically significant evidence of efficacy. The studies that evaluated the effectiveness of animated pedagogical agents were unable to find a general increase in CT score when the method was used in teaching nursing students (Carter, Creedy & Sidebotham, 2016; Oliveira, Díaz, Carbogim, Rodrigues & Püschel, 2016). Trento-intensive tutoring did not have sufficient evidence of efficacy in the reviewed study (Carvalho et al., 2017). Similarly, grand rounds failed to prove the adequate benefit of effectiveness in developing CT skills among undergraduate students. Videotaped vignettes lacked proper support for efficacy in research (Carter, Creed, & Sidebotham, 2016; Mok, So, & Chung, 2016). ICT-based modern approach was not included as one of the effective strategies appraised (Carter, Creedy & Sidebotham, 2016). The clinical laboratory lacked support of efficacy in the reviews because of insignificant differences between the experimental and control groups (Carvalho et al., 2017). Notably, studies that did not have sufficient evidence of effectiveness cannot be used in practice unless additional research is conducted.
Quality of the Evidence
The use of relevant methodology enhances the quality of research or review findings. The researcher assessed and scored the methodological quality of each review independently using the Assessment of Multiple Systematic Reviews (AMSTAR). As a result, the assessments provide quality information relating to the methods of teaching critical thinking skills. The five reviews included were assessed for quality (three evaluations were of high quality while two reports were regarded as moderate). Such quality evidence is useful in practice and for future research.
Potential Biases in the Review Process
The systematic reviews were obtained from three electronic databases, Cumulative Index to Nursing and Allied Health (CINAHL), Scopus, and ScienceDirect, which might have limited the search results. Besides, only systematic reviews published in English were included, creating a language and cultural bias. The included studies were published from 2014 to 2019, which means that the researcher left out all relevant systematic reviews published before 2014. Some of those studies could have provided significant insight into the strategies that can be used to develop critical thinking in nursing. Some of the five reviews have many interventions, which limited detailed analysis and indicates the need for future research.
Nursing students should exhibit critical thinking skills to achieve safety and quality outcomes when working with their patients. Critical thinking should be at the core of nursing education, including at the undergraduate level. Thus, it is crucial to identify effective teaching strategies for training nurses to develop CT ability. The review analyzed the available evidence to identify effective teaching approaches targeted at CT skills development. Some strategies, such as an interactive videodisc system, simulation, problem-solving, evidence-based interventions, concept mapping, narrative pedagogy, and reflective writing were found to be effective. However, other approaches, including high-fidelity patient simulation, animated pedagogical agents, grand rounds, and videotaped vignettes lacked adequate support of effectiveness, hence necessitating more research to evaluate their efficacy.
Implication for Practitioners
Nurse educators can use the outcome of the review to implement their teaching plans in ungraduated settings. They should focus on effective interventions as supported by research evidence of efficacy. While some interventions, such as simulation, can be used independently, the review includes the ones that can blend to become more successful and effective in developing critical thinking skills. Besides, they should use the outcome of the review as the basis for further research on effective teaching methods.
Implication for Researchers
Further research is critical to establish the most effective nursing education strategies to develop critical thinking skills. Research should focus on a plan with inadequate evidence of efficacy and those without statistical significance. It is essential to research the ways of integrating the strategy in a multimodal approach. Research should inform the implementation of the procedures in nurse education at the undergraduate level.