Critical Thinking Disposition and the achievement of critical thinking outcomes in SCPHN education

1. Critical Thinking Dispositionand the achievement of critical thinking outcomes in SCPHN education An assessment and exploration of Critical Thinking Disposition (CTD) of Specialist Community Public Health Nursing Students on a Distance Learning Programme Funding Source Higher Education Academy for Health Sciences

2. Definition of Critical ThinkingAPA Delphi Study 1990 “..purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based…”

3. The Ideal Critical ThinkerAPA Delphi Study 1990 “The Ideal Critical Thinker is habitually inquisitive, well-informed, and trustful of reason. Open-minded, flexible, fair-minded in evaluation, honest in facing personal biases, prudent in making judgments, willing to reconsider, clear about issues, orderly in complex matters, diligent in seeking relevant information, reasonable in the selection of criteria, focused in enquiry, and persistent in seeking results which are as precise as the subject and circumstances of inquiry permit.”

4. Critical Thinking • CT Disposition : “the attitudinal basis for the internal motivation to think critically” • CT Skills - interpretation, analysis, explanation, evaluation, inference and metacognition • Why focus on disposition ? (John Dewey) • Different conceptualisations e.g. Tishman & Andrade, Perkins, Paul & Elder, Facione et al • Important in learning • CT skills & dispositions synergistic • Facione’s conceptualisation of CTD – APA basis & tools

5. Definitions of CTD Elements (Facione 2004) Truthseeking • Intellectual honesty – the desire for best knowledge, the inclination to ask challenging questions and to follow reason and evidence…even if it fails to support or undermines existing knowledge/beliefs and interests Open-mindedness • Tolerance for new ideas and divergent views, self-monitoring for biases

6. Definitions of CTD Elements (Facione 2004) Systematicity • Inclination towards & valuing of being organised e.g. ability to focus and stay focused, diligence in approaching problems Critical Thinking Self-confidence • Trust in one’s own reasoning abilities and capacity to guide others in decision making

7. Definitions of CTD Elements (Facione 2004) Analyticity • Anticipation of and/or alertness to actual or potential problems /consequences – being aware of when there is a need to use reason and evidence to solve problems & demanding its application Inquisitiveness • Intellectual curiosity, eagerness & willingness to learn things even when the immediate application of these things is not obvious

8. Definitions of CTD Elements (Facione 2004) Cognitive Maturity • Capacity to make, suspend, or revise judgements that enable the complexity of problems to be appreciated and to make decisions carefully and cautiously. Awareness of possibility of multiple solutions and need to sometimes reach conclusions in absence of complete knowledge.

9. Research Questions • Are SCPHN students disposed towards critical thinking? • What are SCPHN students’ views on CTD testing? • What do students think the determinants of Critical Thinking Disposition are? • How do students think their CTD can be developed?

10. Approach & Methods • Mixed method: 2 phase sequential explanatory design • Survey = California Critical Thinking Disposition Inventory (CCTDI) on-line • Population & sample = 151 students (OHN & HV) on a distance learning programme • Qualitative exploration using interviews with a convenience sample of 4 respondents (all female).

11. Quantitative Data Collection • CCTDI - 75 item agree-disagree 6 point likert scale • Total scores 0-420; sub-scales scores of 0-60 • Validity & reliability (CA = 0.89) • =/> 280 is +ve disposition, 210-279 = ambivalence towards CTD, <210 indicates a -ve disposition • Sub-scales scores of =/>50 strongly +ve; =/>40 are positive; 31-39 are ambivalent; =/<30 are weak • Positive overall disposition requires scores of >/=40 in all sub-scales • Pre-warning & electronic invitation CCTDI (on-line) through insight assessment.com

12. Quantitative Findings (N=56)Limitations – response rate & possible biases • Mean Age 39.5; 25% with first degree; 48% <3 modules; 98%> 5 years post-reg. • Mean Total CTD Score 289.9 • Total scores negatively skewed & wide range (207-350) • Sub-scales: Mean sub-scale scores for truth seeking & systematicity ambivalent (<40 but >30); widest score ranges in systematicity, CT self-confidence, cognitive maturity, & truth seeking • TS mean > than Facione’s for all years but not returning licensed nurses (RLN) • All others (total & sub-scales scores) < Facione’s for all years & RLN (312.8 n=333)

14. Qualitative Findings • Students found testing interesting & valuable for CT orientation • Life experiences, home environment, cultural background, gender, professional socialization, work culture, personality and confidence were identified as CTD determinants • Higher education experience was seen to promote CTD by supporting questioning and developing confidence to question • CTD depends on learning environments and relationships that support dialogue and questioning • Organisation disposition (systematicity) was linked to organisation skills & learning autonomy

15. Qualitative Findings • Research appraisal skills were seen to be a positive determinant of CTD • Participants related organisation disposition (systematicity) to organisation skills and learning autonomy - they saw the need for a balance between course structure & flexibility • Distance learning students value opportunities for face to face dialogue

17. Conclusions • Some SCPHN students are ambivalent or negatively disposed towards CT • Not all students live and/or work in cultures and/or have relationships that support CTD • Higher education can develop CTD by providing questioning opportunities & developing confidence to question theory & practice • Learning environments and relationships must be supportive of dialogue and questioning

18. Conclusions • Research appraisal skills may enhance CTD • CTD testing with follow on dialogue may support development • Distance learning may be challenging for students with deficits in systematicity • Promoting systematicity requires a balance between course structure & flexibility • Having to develop organisation skills promotes systematicity • CTD development depends on internal motivation based on a belief that development is possible

19. Recommendations • CTD testing with follow on dialogue may support CTD development • Sociological & psychological determinants of CTD should be explored with students and educators • Dispositional strengths could be used to address deficits - truth-seeking & systematicity may be deficits in SCPHN students • Research appraisal skills may help address deficits in truth-seeking & systematicity

20. Recommendations • Learning autonomy may develop systematicity & organization skills • Blended (face to face & on-line delivery) may develop CTD better than fully on-line delivery • Feedback & development should address both skills & dispositions in tandem • Differentiated support in academic and practice learning may be required to support CTD development • Students with negative CTD scores may need development before SCPHN education

23. Data Collection Quantitative • CCTDI - Established face, content, & construct validity & reliability, some issues re reliability of some sub-scales • Correlates with ego-resilience (r=0.58) & openness to experience (r=0.37) p= 0.001 N=198 (Facione et al 1997) • Used extensively in nurse education & other HE studies Qualitative • Semi-structured interviews on test experience; factors perceived to affect CTD and its development

24. Critical Thinking in NursingEmphasis on Disposition & Application in Practice “ An essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits ofmind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection.” Scheffer and Rubenfeld (2000)

25. Summary of Literature Review • CT essential in clinical judgements & critical reflection • Reflective critical thinking important in education for public health (nursing) – assessment of need, design of interventions & evaluation • For CT both dispositions and skills matter - synergistic - lack of CTD limits CT skills development • CTD variation within student & practising nurse populations • Limitations in truth seeking common • Evidence of linkage between CTD and research utilisation

26. Summary of Literature Review • Socio-cultural and political factors as determinants of CT • Limitation in knowledge of CT skills & CTD in nursing populations due to • definition and measurement debates (applied CT or theoretical CT) • validity & reliability of measurement tools • small studies with convenience samples • lack of longitudinal studies

27. Summary of Literature Review • Evidence largely derived from pre-registration nursing students in the North America e.g. Facione et al’s (1997) meta-study (CCTDI & CCTST) • Ambivalent truth seeking scores in nursing students • Pre-post group (n=171) significant (0.05) gains in total CTD, truth-seeking, analyticity & critical thinking self-confidence • Impact of education on licensed nurses returning to study - CTD diminished (312.8 – 309.3) • Lack of CTD evidence to inform UK post-registration nurse education, including DL SCPH nurse education