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ABSTRACT
The impetus for this literature review was an exploratory study conducted by the writer which indicated that a sample of nursing students seemed to make no significant gains in the development of critical thinking over an academic year. Surprised, the writer undertook an analysis of relevant studies in the nursing literature focusing upon the following questions: Does nursing education impact upon critical thinking? Does nursing education impact upon clinical judgment? How do critical thinking and clinical judgment relate? How do critical thinking and achievement in nursing education relate?
This endeavor yielded mixed findings while reference to literature in the field of education produced several insights that help to explain some of the perplexities. Suggestions are offered regarding research and teaching related to critical thinking.
Introduction
The impetus for this review was the writer's surprise and concern that nursing students in an exploratory study that she conducted seemed to make no significant gains in the development of critical thinking over an academic year. The heavy emphasis upon nursing process would lead to the expectation that involvement in nursing education would enhance one's critical thinking ability. Likewise, one would expect that strength in critical thinking would impact upon nursing performance, particularly in terms of clinical judgment.
* Does nursing education generally impact favorably upon the development of critical thinking?
* Does nursing education impact favorably upon the development of clinical judgment?
* What is the relationship between critical thinking and clinical judgment in nursing?
* What is the relationship between critical thinking and achievement in nursing education?
Further analysis of relevant studies in the nursing literature with these questions in mind revealed perplexing findings.
For purposes of this review, the generic nature of the term critical thinking and the discipline-specific nature of the term clinical judgment are conveyed in the following definitions. Critical thinking is "reasonable and reflective thinking that is focused upon deciding what to believe or do" (Norris and Evans as cited in Norris, 1989, p. 21). Clinical judgment is:
... a series of decisions made by the nurse, in interaction with the client regarding (a) the type of observations to be made in the client situation, (b) the evaluation of the data observed and derivation of meaning (diagnosis), and (c) nursing actions...