Strides in Development of Medical Education

Document Type : Original Article


1 Department of Nursing, College of Nursing and Midwifery, Karaj Branch, Islamic Azad University, Karaj, Iran Clinical Cares and Health Promotion Research Center, Karaj Branch, Islamic Azad University, Karaj, Iran

2 Department of Midwifery, College of Nursing and Midwifery, Karaj Branch, Islamic Azad University, Karaj, Iran


Background The lack of clinical competence in nurses leads to problems in providing nursing services. Studies indicate that nurses lacking the required skills can endanger the public health in medical centers. Critical thinking is a factor that can affect nurses' clinical competence. Objectives The current study aimed at investigating the relationship between critical thinking and clinical competence in nurses. Methods The current descriptive-analytical and cross sectional study was conducted on 120 nurses selected by random sampling method. Data collection tools included the California Critical Thinking Disposition Inventory (CCTDI), as well as clinical competence and demographic information questionnaires. Data were analyzed with SPSS using Pearson correlation coefficient, linear regression, and -test. Results Pearson correlation test showed a positive correlation between the total scores of critical thinking and clinical competence. Based on the results of the linear regression analysis, the tendency toward critical thinking could predict 28.4% of the clinical competence. The nurses mean CCTDI scores were at the positive level and their mean clinical competence scores were at the average level. Conclusions According to the obtained results, nursing authorities can organize practical workshops on the development of critical thinking of clinical nurses as one of the most important and operational strategies to improve nursing clinical competence and, ultimately, move towards optimal care.


  1. Karimi Movaseghi H, Gazarani A, Vaghei S, Gholami H, Saleh Moghaddam AR, Ashoori A. [Relationship between spiritual intelligence and nurses’ clinical competency]. J Sabzevar Univ Med Sci. 2011; 18(2): 132–9.Persian.
  2. Adib Hajbaghery M, Eshraghi Arani N. [Assessing nurses’ clinical competence from their own viewpoint and the viewpoint of head nurses: A descriptive study]. Iran J Nurs. 2018;31(111):52–64. Persian. doi:10.29252/ijn.31.111.52.
  3. Namadi vosoughi M, Tazakkori Z, Habibi A, Abotalebi Daryasari GH, Kazemzadeh R. [Assessing nursing graduates0 clinical competency from the viewpoints of graduates and head nurses]. J Health Care. 2014; 16(6):66–73. Persian.
  4. Mazlum R, Ghalje M, Ghaljaee F. [Survey relationship clinical competency and patient satisfaction from nursing service]. J Faculty Nurs Midwifery Shahid Beheshti Univ. 2008;18(63):12–9. Persian.
  5. Parsa Yekta Z, Ahmadi F, Tabari R. [Factors defined by nurses as influential upon the development of clinical competence]. J Guilan Uni Med Sci. 2005;14(54):9–23. Persian.
  6. Habibzadeh H, Ghorbanzadeh K, Khlkhali HR, Mohamadpor Y. [The relationship betweennurses’ quality of work life and their clinical competency]. J Urmia Nurs Midwifery Fac. 2012;10(3):332–9. Persian.
  7. Toghian chaharsoughi N, Irajpour A. [A study on the barriers to critical thinking by nurses, nursing educators and nursing students]. J Med Educ Dev. 2014;7(15):86–93. Persian.
  8. Orujlu S, Maslakpak MH. [Assessing the relationship between critical thinking and self-efficacy of nursing student]. J Nurs Educ. 2017;5(6):11–7. Persian. doi: 10.21859/jne-05062.
  9. Khodaei A, Mansourain M, Ganjei S, Asgari H. [Strategies for decreasing gap between theory and clinical performance from the viewpoints of nursing students in Tabriz University of Medical Sciences]. Res Med Educ. 2016;8(2):49–59. Persian. doi: 10.18869/acadpub.rme.8.2.49.
  10. Toofany S. Critical thinking among nurses. Nurs Manag. 2008;14(9):28–31. doi:10.7748/nm2008.
  11. Facione PA, Facione NC, Giancarlo CA. California critical thinking disposition inventory: Inventory manual. Millbrae: California Academic Press; 2001.
  12. Bahmanpour K, Navipour H, Ahmadi F, Kazemnejad A. [A concept analysis of critical thinking in clinical nursing]. Sci J Kurdistan Univ Med Sci. 2017;22(2):96–109. Persian.
  13. Tajvidi M, Ghiyasvandian S, Salsali M. Probing concept of critical thinking in nursing education in Iran: A concept analysis. Asian Nurs Res (Korean Soc Nurs Sci). 2014;8(2):158–64. doi:10.1016/j.anr.2014.02.005. [PubMed: 25030649].
  14. Carbogim Fda C, Oliveira LB, Puschel VA. Critical thinking: Concept analysis from the perspective of Rodger’s evolutionary method of concept analysis. Rev Lat Am Enfermagem. 2016;24. e2785. doi:10.1590/1518-8345.1191.2785. [PubMed: 27598376]. [PubMed Central:PMC5016005].
  15. Cevik S. An investigation of the critical thinking dispositions of pre-service teachers at a private non-profit university [dissertation]. Ankara: Bilkent University, Institute of Educational Sciences; 2013.
  16. Tümkaya S, Aybek B, Alda¸s H. An investigation of university students’ critical thinking disposition and perceived problem solving skills. Eurasia J Educ Res. 2009;(36):57–74.
  17. Kim S, Nam H, Kim M. Critical thinking disposition, problem solving process, and simulation-based assessment of clinical competence of nursing students in pediatric nursing. Child Health Nurs Res. 2014;20(4):294. doi: 10.4094/chnr.2014.20.4.294.
  18. Yang HJ. Relationship between critical thinking disposition and problem solving ability of nursing students. J Korea Acad Indust Cooperat Soc. 2013;14(12):6387–94. doi: 10.5762/kais.2013.14.12.6387.
  19. Kim KS, Choi JH. The relationship between problem solving ability, professional self concept, and critical thinking disposition of nursing students. Int J Bio Sci Bio Technol. 2014;6(5):131–42. doi:10.14257/ijbsbt.2014.6.5.13.
  20. Jeong HS. Critical thinking disposition, problem solving process, and empathy among nursing students. Adv Sci Technol Lett. 2015:44–8. doi:10.14257/astl.2015.103.10.
  21. Pai HC, Eng CJ. The relationships among critical thinking disposition, caring behavior, and learning styles in student nurses. Open J Nurs. 2013;3(2):249–56. doi: 10.4236/ojn.2013.32034.
  22. Mirmolaei T, Shabani H, Babaei G, Abdehagh Z. [Comparison of critical thinking among first and last trimester baccalaureate midwifery students]. Hayat. 2004;10(3):69–77. Persian.
  23. Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing clinical research. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.
  24. Facione NC, Facione PA, Sanchez CA. Critical thinking disposition as a measure of competent clinical judgment: The development of the California Critical Thinking Disposition Inventory. J Nurs Educ. 1994; 33(8):345–50. doi: 10.3928/0148-4834-19941001-05. [PubMed: 7799093].
  25. Bahman Poor K. Evaluation of the effect of instructing learn critical thinking skills based on problem solving, critical thinking underlying factors, attitudes and behaviors of nursing students in Tehran University of Medical Sciences [dissertation]. Tehran: Tehran University of Medical Sciences; 2003. Persian.
  26. Badry Gargari R, Fathi Azar S. [A comparison of the effect of the group problem based learning and traditional teaching on critical thinking of teacher students]. Stud Educ Psychol. 2007;8(2):27–42. Persian.
  27. Benner P. From novice to expert: Excellence and power in clinical nursing practice. New Jersey: Commemorative; 2001. p. 44–6.
  28. Meretoja R, Isoaho H, Leino-Kilpi H. Nurse competence scale: Development and psychometric testing. J Adv Nurs. 2004;47(2):124–33. doi:10.1111/j.1365-2648.2004.03071.x. [PubMed: 15196186].
  29. Bahreini M, Moattari M, Kaveh MH, Ahmadi F. [A comparison of nurses’ clinical competences in two hospitals affiliated to Shiraz and Boushehr Universities of Medical Sciences: A self-assessment]. Iran J Med Educ. 2010;10(2):101–10. Persian.
  30. Bahreini M, Moatari M, Kaveh MH, Ahmadi FA. [Determining nurses’ clinical competence in hospitals of Shiraz University of Medical Science by self-assessmentmethod]. J Med Sci Jahrom. 2010;8(1):29–35. Persian. doi: 10.29252/jmj.8.1.28.
  31. Mohammadi SD, Moslemi Z, Ghomi M. [The relationship between critical thinking skills with creativity and academic achievment among students inQom University of Medical Sciences]. Educ Strategy Med Sci. 2016;9(1):79–89. Persian.
  32. Facione PA. Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction. Executive summary "the delphi report". Millbrae, CA: California Academic Press; 1990.
  33. McKinley C, Fletcher A, Biggins A, McMurray A, Birtwhistle S, Gardiner L, et al. Evidence-based management practice: Reducing falls in hospital. Collegian. 2007;14(2):20–5. doi: 10.1016/s1322-7696(08)60551-x.
  34. Kırba¸slar M, Özsoy-Güne¸s Z. The effect of critical thinking disposition on entrepreneurship levels: A study on future teachers. Procedia Soc Behav Sci. 2015;174:199–207. doi: 10.1016/j.sbspro.2015.01.647.
  35. Paryad E, Javadi N, Atrkar Roshan Z, Fadakar K, Asiri SH. [Relationship between critical thinking and clinical decision making in nursing students]. Iran J Nurs. 2011;24(73):63–71. Persian.
  36. Nasrabadi HA, Mousavi S, Kaveh Farsan Z. [The contribution of critical thinking attitude and cognitive learning styles in predicting academic achievement of medical university’s students]. Iran J Med Educ. 2012;12(4):285–96. Persian.
  37. Baba Mohammadi H, Khalili H. [Critical thinking skills of nursing students in Semnan University of Medical Sciences]. Iran J Med Educ. 2004;4(2):23–31. Persian.
  38. Fathi Azar E. Teaching methods and techniques [dissertation]. Tabriz: Tabriz University; 2003. Persian.
  39. Behrens PJ. The watson-glaser critical thinking appraisal and academic performance of diploma school students. J Nurs Educ. 1996;35(1):34–6. [PubMed: 8926515].
  40. King PM, Wood PK, Mines RA. Critical thinking among college and graduate students. Rev High Educ. 1990;13(2):167–86. doi:10.1353/rhe.1990.0026.
  41. Abbasi P, Sepahi V, Khoshay A, Iranfar S, Timareh M. [Critical thinking disposition and its relationship with self-esteem in pre-clinical and clinical medical students of Kermanshah University of Medical Sciences]. Iran J Med Educ. 2013;13(6):498–508. Persian.
  42. Wangensteen S, Johansson IS, Bjorkstrom ME, Nordstrom G. Critical thinking dispositions among newly graduated nurses. J Adv Nurs. 2010;66(10):2170–81. doi: 10.1111/j.1365-2648.2010.05282.x. [PubMed:20384637]. [PubMed Central: PMC2984541].
  43. Ricketts JC, Rudd R. Critical thinking skills of FFA leaders. J South Agricult Educ Res. 2004;54(1):7–20.
  44. Gharib M, Rabieian M, Salsali M, Hadjizadeh E, Sabouri Kashani A, Khalkhali H. [Critical thinking skills and critical thinking dispositions in freshmen and senior students of health care management]. Iran J Med Educ. 2009;9(2):125–35. Persian.
  45. Sabouri Kashani A, Faal Ostadzar N, Karimi Moonaghi H, Gharib M. [Critical thinking dispositions among medical students in two stages: Basic medical sciences and pre-internship]. Iran J Med Educ. 2013;12(10):778–85. Persian.
  46. Ojewole FO, Thompson CE. Assessment of critical thinking dispositions on nursing students in Southwestern Nigeria. Int J Res Appl. 2014;2(3):7–16.
  47. Ozdemir SM. An evaluation of university students critical thinking skills with some variables. J Turk Educ Sci. 2005;3(3):297–314.
  48. Kawashima N, Shiomi K. Factors of the thinking disposition of Japanese high school students. Soc Behav Person Int J. 2007;35(2):187–94. doi: 10.2224/sbp.2007.35.2.187.
  49. Azar A. The effect of critical thinking dispositions on students achievement in selection and placement exam for university in Turkey. J Turk Sci Educ. 2010;7(1):61–73.
  50. Nazem Ghadi IN, Abu Bakar K, Alwi NH, Talib O. Gender analysis of critical thinking disposition instrument among university putra malaysia undergraduate students. Recent Technol Adv Educ. 2012: 27–33.
  51. Kolayi¸s H. The comparison of critical thinking and problem solving disposition of athletes according to gender and sport type. Int J Hum Sci. 2014:842–9. doi: 10.14687/ijhs.v11i2.3051.
  52. Shabouni Z, Nouhi E, Okhovati M. [The effect of team-based learning inmedical information systems course on academic achievement in postgraduate students of Kerman University of Medical Sciences, Iran]. Strides Dev Med Educ. 2016;13(1):75–83. Persian.
  53. Khoda Moradi K, Saeid Alzakerin M, Alavi Majd H, Yaghmaei F, Shahabi M. [Translation and psychometric properties of California critical thinking skills test (form B)]. J Facult Nurs Midwifery Quart. 2007;16(55):12–9. Persian.
  54. Noohi E, Salahi S, Sabzevari S. [Association of critical thinking with learning styles in nursing students of School of Nursing and Midwifery, Iran]. J Strides Dev Med Educ. 2014;11(2):179–86. Persian.
  55. Komeili Sani H, Etemadi A, Boustani H, Bahreini M, Hakim AS. [The relationship between nurses’ clinical competency and job stress in Ahvaz University Hospital, 2013]. J Clin Nurs Midwifery. 2015; 4(1): 39–49.Persian.
  56. Lin MC, Chen CH. An investigation on the nursing competence of southern Taiwan nurses who have passed N3 case report accreditation. J Nurs Res. 2004;12(3):203–12. doi:10.1097/01.JNR.0000387504.21749.c3. [PubMed: 15362012].
  57. Santiano N, Daffurn K. Registered nurses’ self-perceived level of competence following completion of a specialist graduate certificate. Aust Crit Care. 2003;16(1):16–23. doi: 10.1016/S1036-7314(03)80024-3. [PubMed: 18038518].
  58. Garland GA. Self report of competence. A tool for the staff development specialist. J Nurs Staff Dev. 1996;12(4):191–7. [PubMed: 8936163].
  59. Meretoja R, Leino-Kilpi H, Kaira AM. Comparison of nurse competence in different hospital work environments. J Nurs Manag. 2004;12(5):329–36. doi: 10.1111/j.1365-2834.2004.00422.x. [PubMed:15315489].