ABSTRACT

Results from previous studies indicated nursing students needed to further develop critical thinking (CT) especially with respect to employing it in their clinical reasoning. Thus, the study was conducted to support development of students’ CT in the areas of inference subskills that could be applied as they engaged in clinical reasoning during course simulations. Relevant studies from areas such as CT, clinical reasoning, nursing process, and inference subskills informed the study. Additionally, the power of simulation as an instructional technique along with reflection on those simulations contributed to the formulation of the study. Participants included junior nursing students in their second semester of nursing school. They completed a pre- and post-intervention Critical Thinking Survey, reflective journals during the course of the intervention, and interviews as the conclusion of the study. The intervention provided students with instruction on the use of three inference subskills (Facione, 2015). Moreover, they wrote reflective journal entries about their use of these skills. Quantitative results indicated no changes in various CT measures. By comparison, qualitative data analysis of individual interviews and reflective journals showed students: applied inference subskills in a limited way; demonstrated restricted clinical reasoning; displayed emerging reflection skills; and established a foundation on which to build additional CT in their professional roles. Limitations of the study included time—length of the intervention and limited power of the instruction—depth of the instruction with respect to teaching the inference subskills. Discussion focused on explaining the results. Implications for teaching included revision of the instruction in inference subskills to be more robust by extending it over time, perhaps across courses. Additionally, use of a ‘flipped’ instructional process was discussed in which students would learn the subskills by viewing video modules prior to class and then are ‘guided’ to apply their learning in classroom health care simulations. Implications for research included closer examination of the development of CT in clinical reasoning to devise a developmental trajectory that might be useful to understand this phenomenon and to develop teaching strategies to assist students in learning to use these skills as part of the clinical reasoning process.