Definitions of and reported enhancer and barriers to critical thinking by nurses working in long term care facilities.

摘要

Background. Nursing acknowledges that critical thinking is an important as a guideline for decision making to ensure positive patient outcomes. Yet, there is a lack of agreement on the definition, how to teach it, and how to evaluate it in the clinical setting. Studies suggest that factors within the work environment enhance or pose barriers to nurses' ability to utilization of these skills.;Purpose. The purpose of this study is to evaluate the definition of critical thinking by nurses working in long term care facilities and identify their perceived enhancers and barriers to utilization in practice.;Method. Descriptive, qualitative design. Convenience sample of nurses at three long term care facilities in the Denver metropolitan area. Inclusion criteria: Registered nurses, English literate. Age: 21 to 65 years, n=11. Exclusion criteria: unable to complete the questionnaire, unwilling to volunteer. Eligible participants were provided with a survey instrument and participated in a focus group discussion at each of the sites.;Data analysis. Data from the survey instrument were recorded, coded, and clustered into themes or analyzed using descriptive statistics. Responses to focus groups questions were recorded, coded, and clustered into themes and compared to the survey instrument.;Findings. 11 participants---10 females, 1 male, 8 whites, 3 African-Americans. Data concerning definitions of critical thinking demonstrated elements of the accepted definition by nursing experts. Enhancers and barriers to practice included teamwork, staffing patterns, staff and administrator support. Relationships with this patient population were the most satisfying factor. Paperwork responsibilities were the least satisfying factor.;Conclusions/recommendations. Nurses' definitions of critical thinking are consistent with acknowledged definitions. They are able to describe factors that both enhance this process as well as posing barriers consistent with previous studies. Recommendations include a need for further evaluation of work environment factors that affect nurses' performance, support for nursing education to pursue consistent methods for teaching and evaluating outcomes of critical thinking skills, the need for nursing administrators to consider the work environment aspects that affect performance and consider the life long learning needs for increased competency in practice.