Century Nurse: Theory, Instruments, and Methodologies for Measuring Clinical Thinking

This cross-sectional descriptive study of the Model of Domain Learning, which describes learners’ progress from acclimation through competence to proficiency through the interplay of knowledge, interest and strategic processing/critical thinking (CT), examined its extension to maternity nursing. Based on the identified need for valid, reliable quantitative instruments measuring cognitive and affective aspects, three instruments were developed: a 20item, polytomously-scored multiple choice questionnaire, a five item Interest Survey, and a written CT case scenario analysis. The sample was 87 baccalaureate student nurses in the third and final semesters. The instruments demonstrated mixed support for the Knowledge, Interest, and CT scales. Three principal component factors mapped well onto current definitions of CT. Further refinement of instruments and a broader sample were recommended. The complexity of the current health care system has placed increasing demands on health professional education. Patients are sicker, older, and more culturally diverse, and the structure of the health care system is constantly fluctuating due to changes in insurance, regulations, and technology. An understanding of the trends making demands on professional education will improve the application of theories, instruments, and methodological solutions. Regarding trends in patient care, patient classification systems have indentified increases in such measures as the average case mix index (Jennings, 2008) that indicate a more complex caseload for nursing care. Technologies used in the care of patients such as pumps, robots, medication delivery systems, computers and documentation systems, are changing every day, and increasing consumerism in patients has added a new dimension to patient teaching (Cohen, Grote, Pietraczek, & Laflamme, 2010). Another trend that is increasing the complexity of care is the aging of the U.S. population, with an increasingly diverse racial and ethnic composition (Jacobsen, 2011). The demographics of nursing students themselves are changing as the profession becomes more racially, ethnically, internationally, and socioeconomically diverse, with increased gender and age distribution (AACN, 2008). The new Health Care Reform laws and regulations will require nurses to care for patients more safely, accurately, and in a manner that utilizes evidence-based practice. The new programs will utilize more community-based settings where access to experienced mentors may be decreased (AACN, Apr. 2010). The quality assurance demands via audit increase every day, as the cost and efficiency of care delivery are scrutinized more closely (RWJF, Dec. 2008). Regarding trends in nursing education, there have been widespread professional calls for improvements in the education of nurses. The Institute of Medicine (IOM) is an independent non-profit that is an arm of the National Academy of Sciences that serves as a national advisor on health. Its recent report, The Future of Nursing(2008), calls for increases in decision-making skills of nurses in educational programs. The Carnegie Foundation for the Advancement of Teaching recently released Educating Nurses in the Preparation for the Professions series, which recommends that nurse educators emphasize clinical reasoning that incorporates the many factors that must be considered in providing nursing care (Benner, Sutphen, Leonard, and Day,