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Traditionally undergraduate nursing curricula focused on content and competencies required of new graduates upon entry into professional practice, usually in a hospital setting. Today new graduates begin their first professional nursing positions in diverse settings, from outpatient ambulatory care to specialized intensive care units, all requiring very different skill sets and knowledge. Because the content is too exhaustive to teach everything to students, the goals of undergraduate nursing education have shifted to the preparation of thinkers and lifelong learners. As described by Jones and Brown (1991), "nurse educators can no longer provide a sufficient knowledge base of facts to circumscribe professional nursing practice. Not only are there far too many facts, but there are far too many facts which become erroneous over time" (p. 533). They go on to describe the dynamic nature of health care and how the increasing technology and complexities of care required of many clients demand higher-order thinking skills (Jones & Brown, 1991). More attention is being given to learning how to learn as the primary focus of adult education (Billings & Halstead, 2005). Increasing complexities of the health care environment and the rapid changes in the delivery of health care demand that nurses master complex information, effectively use technology and skillfully coordinate a variety of health care experiences for their patients.
Critical thinking is considered essential to the provision of safe, appropriate, relevant care to clients in a variety of settings in a practice discipline such as nursing. The importance of critical thinking is directly related to the complexity of the current health care environment, as well as to ever-changing and expanding technologies. Synthesis and integration of multiple forms of knowledge are required for effective clinical decision making (Kramer, 1993). Registered nurses need critical thinking abilities to provide safe, competent, skilflul care to clients (Brunt, 2005; Kataoka-Yahira & Saylor, 1994). For these reasons, nursing education has attempted to address the need for developing critical thinking in nursing students by making it one of the essential core competencies for nurses in the 21st century, as identified by the American Association of Colleges of Nursing (AACN, 1998) and the National League for Nursing Accreditation Commission (NLNAC, 2005). These competencies underlie independent and interdependent decision-making critical for effective clinical judgment (Beckie, Lowry...