Effectiveness of teaching strategies on the development of critical thinking in undergraduate nursing students: a meta-analysis

Oliveira, Larissa Bertacchini de; Díaz, Leidy Johanna Rueda; Carbogim, Fábio da Costa; Rodrigues, Adriano Rogério Baldacin; Püschel, Vilanice Alves de Araújo

doi:10.1590/S0080-623420160000200023

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REVIEW ARTICLE • REEUSPRev. esc. enferm. USP 50 (02) • Apr 2016 • https://doi.org/10.1590/S0080-623420160000200023 copy

Effectiveness of teaching strategies on the development of critical thinking in undergraduate nursing students: a meta-analysis ^* * Extracted from the dissertation, "Efetividade das estratégias de ensino para o desenvolvimento do pensamento crítico em estudantes de graduação em Enfermagem: revisão sistemática e metanálise", Programa de Pós-graduação em Enfermagem na Saúde do Adulto, Escola de Enfermagem, Universidade de São Paulo, 2014.

Efectividad de las estrategias de enseñanza en el desarrollo del pensamiento crítico de estudiantes de pregrado de enfermería: un metaanálisis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To evaluate the effectiveness of teaching strategies used for development of critical thinking (CT) in undergraduate nursing students.

METHOD

Systematic review with meta-analysis based on the recommendations of the Joanna Briggs Institute . Searches were conducted in the following databases: PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, LILACS, Cochrane CENTRAL, PsycINFO, ERIC, and a database of theses from four continents. The initial selection and evaluation of studies and assessment of methodological quality was performed by two reviewers independently.

RESULTS

Twelve randomized clinical trials were included in the study. In the meta-analysis of the four studies included that evaluated the strategy of problem-based learning (PBL), compared to lectures, the effectiveness of PBL was demonstrated with statistical significance (SMD = 0.21 and 95% CI = 0.01 to 0.42; p = 0.0434) for the development of CT in undergraduate nursing students, and the studies were homogeneous (chi-square = 6.10, p = 0.106).

CONCLUSION

The effectiveness of PBL was demonstrated in the increase of overall CT scores. Further studies need to be conducted in order to develop, implement and evaluate teaching strategies that are guided in high methodological rigor, and supported in theoretical models of teaching and learning.

Descriptors
Thinking; Students, Nursing; Education, Nursing; Randomized Controlled Trial; Review

Author (Year) (country)	Sample size	Intervention	Comparison	Duration of intervention	Measurement tools	Results
Tiwari et al. (2006) (China) ²⁷27 Tiwari A, Lai P, So M, Yuen K. A comparison of the effects of problem-based learning and lecturing on the development of students' critical thinking. Med Educ [Internet]. 2006 [cited 2015 Aug 26];40(6):547-54. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2929.2006.02481.x/epdf http://onlinelibrary.wiley.com/doi/10.11...	79 first-year students	Problem-based learning (PBL)	Lectures	2 semesters	California Critical Thinking Disposition Inventory (CCTDI)	The PBL group had overall CT scores measured by the CCTDI that were significantly higher than the lectures group (p=0.005)
Ferguson (2012) (USA) ²⁸28 Ferguson RA. Critical thinking skills in nursing students: using Human Patient Simulation [thesis]. California: Northern California University; 2012.	57 first-year students	Two groups were used: 1 - Traditional lectures + microsimulation + Human Patient Simulation (HPS) 2 - Traditional lectures + Microsimulation + HPS, and after one week a new HPS session without the mentor was performed	Used lectures and micro-simulation	2 weeks	Watson Glaser Critical Thinking Appraisal (WGCTA)	There was no statistically significant difference in overall CT score on the pre-test and post-test examination for all groups
Atay & Karabacak (2011) (Turkey) ¹⁵15 Atay S, Karabacak U. Care plans using concept maps and their effects on the critical thinking dispositions of nursing students. Int J Nurs Pract [Internet]. 2012 [cited 2015 Aug 18];18(3):233-9. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1440-172X.2012.02034.x/epdf . http://onlinelibrary.wiley.com/doi/10.11...	80 first- and second- year students	Concept map in the development of nursing care plans	Traditional method using column format	1 semester	CCTDI	There was no statistically significant difference between the groups. In the experimental group, the difference on the pre- and post-test was statistically significant (p=0.000)
Jun et al. (2013) (South Korea) ²⁹29 Jun WH, Lee EJ, Park HJ, Chang AK, Kim MJ. Use of the 5E learning cycle model combined with Problem-Based Learning for a fundamentals of nursing course. J Nurs Educ. 2013;52(12): 681-9.⁾	161 second-year students	5E learning model combined with PBL	Lectures and discussion groups	5 weeks	Critical Thinking Disposition Scale for Nursing Students	Significant increase in capacity for CT (p=0.005) in the experimental group
Naber & Wyatt (2014) (USA) ³⁰30 Naber J, Wyatt TH. The effect of reflective writing interventions on the critical thinking skills and dispositions of baccalaureate nursing students. Nurse Educ Today [Internet]. 2014 [cited 2015 Aug 26];34(1),67-72. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S0260691713001251 http://www.sciencedirect.com/science/art... ⁾	70 first-year students	Reflective writing based on Richard Paul's CT Model	There was no intervention, the traditional method already used in the discipline was used	8 weeks	California Critical Thinking Skills Test (CCTST) and CCTDI	No significant differences were observed in CT scores measured by the CCTDI (p=0.690) and CCTST (p=0.260)
Ousley (2012) (USA) ³¹31 Ousley TL. The Development of Critical Thinking with Technology in Nursing Education [thesis]. Chicago: Northcentral University; 2012.⁾	132 second-year students	Two groups were used: 1 - Lecture (4 hours) + Simulation (8 hours) + 32 hours of clinical practice 2 - Lecture (4 hours) + Online Case Studies (8 hours) + 32 hours of clinical practice	Only lectures (12 hours) + 32 hours of practice.	4 weeks	CCTST	All groups showed significant changes on the pre- and post-test for overall CT (p<0.010)
Wheeler and Collins (2003) (USA) ¹⁶16 Wheeler LA, Collins SKR. The influence of concept mapping on critical thinking in baccalaureate nursing students. J Prof Nurs [Internet]. 2003 [cited 2015 Aug 22];19(6), 339-46. Available from: Available from: http://www.sciencedirect.com/science/article/pii/S8755722303001340 . http://www.sciencedirect.com/science/art... ⁾	76 second-year students	Concept maps	Traditional method	7.5 weeks	CCTST	There was no significant statistical difference. In the experimental group significant difference of overall CT was found between the pre- and post-test (p=0.020)
Yuan et al. (2008) (China) ¹⁴14 Yuan D, Kunaviktikul W, Klunklin A, Williams BA. Improvement of nursing students' critical thinking skills through problem-based learning in the People's Republic of China: a quasi-experimental study. Nurs Health Sci [Internet]. 2008 [cited 2015 Sept 01];10(1):70-6. Available from: Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1442-2018.2007.00373.x/epdf http://onlinelibrary.wiley.com/doi/10.11...	46 second-year students	PBL	Lectures	18 weeks	CCTST	There was a statistically significant difference between the PBL and lecture groups for overall CT (p=0.040) after intervention
Morey (2012) (USA) ³²32 Morey DJ. Development and evaluation of web-based animated pedagogical agents for facilitating critical thinking in nursing. Nurs Educ Perspect. 2012;33(2):116-20.⁾	50 students in their last semester	Animated Pedagogical Agents (APA). Using an online tool, students performed three case studies, which they received in writing and that were narrated by APA.	Online case studies		Critical Thinking Process Test (CTPT)	There was no statistically significant difference between the overall CT scores in the groups after the intervention (p=0.561)
Yu et al. (2013) (China) ³³33 Yu D, Zhang Y, Xu Y, Wu J, Wang C. Improvement in critical thinking dispositions of undergraduate nursing students through problem-based learning: a crossover-experimental study. J Nurs Educ. 2013;52(10):574-81.	76 second-year students	PBL. Because it was an experimental crossover study , both groups received the interventions PBL and lecture-based learning (LBL) at different times	LBL	One semester	CCTDI-CV (Chinese version)	The group that learned first with PBL showed a statistically significant increase of overall CT (p=0.032), as well as the second group (p=0.048)
Chen et al. (2011) (China) ³⁴34 Chen S, Liang T, Lee M, Liao IC. Effects of concept map teaching on students' critical thinking and approach to learning and studying. J Nurs Educ. 2011;50(8):466-9.	95 second-year students	Concept map + Lectures	Lectures	15 weeks	Critical Thinking Scale (CTS)	No statistically significant differences were found between the groups
Brown (2008) (USA) ³⁵35 Brown SC. The impact of high fidelity simulation and role modeling in the acquisition of critical thinking skills and self-efficacy: an experimental study [thesis]. Colorado: University of Northern; School of Nursing, College of Natural and Health Sciences; 2008.⁾	67 final- year students	High-fidelity simulation with the use of HPS + Debriefing + Role Modeling	High-fidelity simulation with the use of the HPS + Debriefing.	4 days	Professional Judgment Rating Form (PJRF)	No statistically significant differences were found between the groups

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[1] Corresponding author: Larissa Bertacchini de Oliveira. Av. Dr. Enéas de Carvalho Aguiar, 419. CEP 05403-000 - São Paulo, SP, Brazil. larabeta@usp.br