Critical Thinking Module Part 2 for LPN students

Executive Summary

Critical thinking is an essential process for solving the problems of patients while allowing the delivery of safe, efficient, and skillful nursing interventions. It represents a process of analyzing, synthesizing, and evaluating information collected through observation or experience leading to the conviction of action. A curriculum gap identified in the institution prompted the implementation of a critical thinking module into the LPN course. The general underpinning of this curriculum proposal is the ADDIE model of instructional development that involves the phases of analysis, design, development, implementation, and evaluation.

The analysis phase of the model was utilized to assess the needs of the learners and identification of the gap that was filled by the implementation of the critical thinking module. In collaboration with key stakeholders such as the administration, academic nurse educators, and the learners, it was determined that introduction of the critical thinking course could prepare students to deal with today’s challenging healthcare environment.

The design phase of the model was utilized to determine the most important elements of instruction including the goals of the new course. A collaborative approach with stakeholders like the clinical nurse educators, academic nurse educators, and the administration enabled the identification of learning resources, learning objectives, and instructional strategies.

During the development phase, the nurse educators developed the curricula by cultivating dynamic elements of the course. Both independent and collaborative approaches led to the creation of the course content, learning materials, and assessments. To assess the student’s performance, a formative, summative objective, and summative performance assessment were developed.

In the implementation phase of the ADDIE Model, nurse educators continuously modify the newly developed curriculum to ensure overall quality, effectiveness, and efficiency. Human resources utilized during the implementation included the administration, information technology team, academic nurse educators, and hospital clinical nurse educators. Financial resources for implementation included funds to coordinate meetings, educational sessions, and payment of the course instructors.

The last phase of the curriculum development involved the evaluation of the module and its effectiveness to achieve desired goals. The evaluation process mainly involved the analysis of the course performance metrics and student response surveys. This phase provided an opportunity to ascertain if the learner’s and faculty goals were met.

Critical Thinking Module for LPN Students

In today’s complex healthcare environment, critical thinking is applied by nurses in solving patients’ problems and decision-making processes. Critical thinking is a mental-active process that involves the synthesis of gathered information to guide actions in patient care (Sommers, 2018). Nurses are required to adopt positions that promote critical thinking and refine skills of critical reasoning using the limited resources available. To provide this level of care, vigilance in the training and instruction of nurses should be adopted across all institutions. Educators might be successful in teaching the basics of nursing, but it does not mean the students will be able to analyze, evaluate and apply what they are taught. Facilitating critical thinking remains a challenge for both students and educators today due to the increasing complexity of learning and changing demands of patients (Vuckovic et al., 2019). To address this challenge, the only solution available is to design nursing modules that will educate students on critical thinking and its application in clinical practice.

Critical thinking is an essential process for safe, skillful intervention and efficient patient care delivery. Nurses have diverse multifaceted roles and work in a clinically challenging environment that requires making fast decisions using limited resources. Combining critical thinking and creativity helps nurses to overcome challenges at work while saving lives. For the last ten years, nursing programs have mushroomed in the United States leading to the production of more nurses to meet the increasing shortage of nurses. For instance, the American Association of Colleges of Nursing (AACN) indicates that there are over 996 baccalaureate nursing programs today (AACN, 2020). In 2018, there were about 363,433 enrollments from 688 nursing programs and the numbers are even more today. These statistics indicate that more nurses are being prepared at a basic level and above and critical thinking should be part of their curriculum to enable adjustment to the complex healthcare system.

Public demands for quality healthcare today translate into an abundance of careers for nurses. The focus of this proposal is on Licensed Practical Nurses (LPN) that are significant in the delivery of quality nursing care to patients. LPNs attend shorter schooling of about 18 months and their work mostly focuses on ‘doing’ skills necessary to care for patients. These individuals work under the supervision of registered nurses and doctors in medical offices, hospitals, and home-based care facilities. LPNs carry out tasks that are more complex than those of nursing aides including monitoring patients, providing basic care, discussing care with patients, identifying the needs of patients, and reporting to RNs or doctors. To effectively perform these tasks, the nurses must be equipped with the knowledge to handle the diverse needs of patients including utilization of critical thinking.

Academic Setting

The academic setting observed for this clinical practice experience involves LPN students from Athens Technical College School of Nursing. This institution is accredited to provide nursing education at different levels including diploma and Associate Degrees of Nursing. Of particular interest for this clinical practice experience are LPN students seeking education to provide nursing care services to patients upon completion of the course. The student population in this course are from diverse ethnic backgrounds including African American, Caucasian, or Hispanic. Athens Technical College utilizes both on-campus and online learning platforms to foster student learning. The institution allows for traditional week-day learning that inspires students to actively participate in the learning process. To ensure students are well-prepared for clinical area practice, curriculum revisions are discussed in meetings held every month. The nursing faculty reviews the curriculum yearly to incorporate any new approaches discussed during the monthly meetings.

Curriculum Gap

After reviewing the syllabus, the curriculum gap identified was the lack of a course that adequately prepared LPN students to engage in critical thinking during their clinical practice. It was observed that much emphasis was put on educating students to utilize their knowledge in making decisions about patient care. Most of the students relied on classroom teaching using the traditional lecture method to acquire the necessary skills for nursing practice. This approach seemed ineffective in promoting critical thinking because students did not have adequate experience and exposure to real-life situations.  There was a need to incorporate a critical thinking module that would enlighten students on the necessary skills required and the importance of using this approach in nursing today.

To effectively promote critical thinking among students, baseline knowledge on how to solve complex situations and coming up with solutions must be taught. Additionally, different learning strategies ought to be utilized to provoke critical thinking among students. As expressed in the constructivist learning theory, teaching is not about focusing on the subject or lesson, but rather the focus on the learner to think about learning (Fernando & Marikar, 2017). The current curriculum failed to utilize learning approaches that could prompt students to learn. For example, failure to actively involve students in their learning meant that the construction of critical thinking was limited. The introduction of a curriculum that could inform students about critical thinking and utilize different learning strategies could serve to reduce the identified gap in the nursing curriculum.

Proposed Course

Based on the needs gap analysis and input from essential stakeholders, it was determined that students should have the skills necessary to guide patient care in diverse environments. It was crucial to adequately prepare students to make decisions during crucial times and to take responsibility for their actions. To accomplish these tasks, a critical thinking module for the students was proposed and added to the current curriculum. During the education of this course, the students will be prepared to utilize diverse skills in managing patients through the understanding of the critical thinking process and what it takes to be a good critical thinker. Additionally, the simulation lab approach was proposed to accompany the classroom teaching to demonstrate patient care and the decision-making process that could translate to positive patient outcomes. By incorporating critical thinking in the LPN course, students will be prepared to provide care across the illness continuum, have the skills and knowledge to address the physical and psychological needs of patients and facilitate patient autonomy and choice.

Theoretical Framework

The theoretical framework that underlines this proposal is the constructivist learning theory. The constructivist theory is based on the idea that learners are active participants in their learning journey and that knowledge is constructed based on experiences (Fernando & Marikar, 2017). It is observed that learners reflect on their experiences and incorporate new ideas into prior knowledge as events occur. When using the constructivist theory, the learner selects and transforms information, constructs hypotheses, and makes decisions relying on cognitive structure. For instance, the learner can generate meaning and organize experiences that allow them to go beyond the information given. This theory strongly supports the idea of thinking critically and making decisions based on the knowledge gained (Fernando & Marikar, 2017). The theory of constructivism is crucial to understanding how students learn because it demonstrates how learning is an active mental work rather than passive reception of thinking.

The constructivist learning theory is based on different principles or elements that demonstrate the acquisition of knowledge (Fernando & Marikar, 2017). These elements include:

Knowledge is constructed: The theory suggests that every student begins the learning journey with some knowledge and then continues to build on that. During the learning process, the student selects pieces of the experience to add, and this makes everyone’s knowledge unique.

Learning is a social activity: The theory highlights the importance of interacting with others to construct knowledge. Group work, discussions, conversations, and interactions are all important to creating understanding. The student reflects on past experiences and connects with others to generate new ways of handling situations.

Learning is an active process: The theory emphasizes that building meaningful ideas requires sensory responses. The students must actively engage in activities or discussions to enable the retention of information.

Learning is contextual: Constructivist learning does not occur in isolation, but rather through forging connections between personal beliefs and the acquired information. Learning occurs within the context of the student and classification of information as it fits into one’s life translates to learning.

Learning exists in the mind: The theory highlights those hands-on activities and physical experience are not enough to retain knowledge. It is observed that students must experience activities in the mind as well for learning to occur.

Knowledge is personal: This element is crucial to understanding why critical thinking levels vary across populations. The constructivist theory acknowledges that each individual’s perspective is unique, and so is the knowledge gained. Every individual comes into the learning activity with their own experiences and will take away different things as well.

Motivation is key to learning: This element sees the creation of connections and understanding of learning as a result of motivation. Students cannot learn if they are unwilling to reflect on preexisting knowledge. Nurse educators must find ways to motivate students for effective learning and generation of meaning.

The constructivist learning theory emphasizes the role of instructors in promoting learning and influencing critical thinking. Compared to the traditional classroom method, instructors using this approach take on the role of a facilitator instead of a director (Fernando & Marikar, 2017). Secondly, this learning approach gives equal authority and responsibility between the student and the instructor. To foster student learning, knowledge must be shared between the students and the instructor where discussions form the basis of learning. It is established that constructivist classrooms are more student-centered, and learning revolves around the student’s interests and questions (Fernando & Marikar, 2017). The following table highlights a few differences that make constructivist classrooms better than traditional classrooms regarding knowledge acquisition to foster critical thinking.

Figure 1: Constructivist vs Traditional classroom learning: Source (Fernando & Marikar, 2017).

Purpose and Overview

The purpose of this proposal is to recommend a critical thinking module to address the critical thinking gap for LPN students. Upon completion of the module, students will be able to understand the importance of critical thinking and how it can be applied to manage the diverse needs of patients. The rationale for this proposal is that the critical thinking module will ensure the students are sufficiently prepared to practice safely, effectively, and autonomously. The module will engage students, provoke their thoughts, and create meaningful learning experiences that will help them solve critical problems during routine patient care. To fully address the identified problem, a literature review was conducted to identify peer-reviewed sources supporting the use of critical thinking in nursing today. The discussion provides evidence to address the curriculum gap in the literature review section and proceeds to use the ADDIE (analysis, design, development, implementation, and evaluation) model to address the change proposal. The last part is the conclusion that highlights key points of the curriculum proposal.

Critical Thinking Module Part 2 for LPN students

Literature Review

Refer to Table1: Literature Review Summary table

Curriculum Gap and Potential Causes

After reviewing the syllabus, the curriculum gap identified is the lack of a course that adequately prepared LPN students to engage in critical thinking during their clinical practice. It is observed that much emphasis is put on educating students to utilize their knowledge in making decisions about patient care. Most of the students rely on classroom teaching using the traditional lecture method to acquire the necessary skills for nursing practice. This approach seems ineffective in promoting critical thinking because students do not have adequate experience and exposure to real-life situations. Additionally, it is challenging for students to deal with patients requiring special needs, especially mental health patients. For instance, lack of adequate mental facilities to allow students to get enough experience is a major factor hindering critical thinking application. There is a need to incorporate a critical thinking module that would enlighten students on the necessary skills required and the importance of using this approach in nursing today.

There are a few potential causes that might contribute to this curriculum gap. Firstly, lack of enough focus on changing the nursing curriculum can lead to inefficiencies in preparing students. The curriculum change process is a tiresome process that requires regular meetings, time allocation, and availability of finances that might otherwise be a challenge to the curriculum masters. The interest to change the curriculum to incorporate new practices may be varied across instructors leading to mixed thoughts (Fawaz et al., 2018). For example, the aging instructors may fail to understand how student-centered learning may affect critical thinking because they are used to the traditional instruction methods.

The second probable cause of the identified gap is the lack of enough faculty knowledge on how to foster the new approach to student learning. Critical thinking may be challenging to many because it is a new approach to learning. Perhaps the nursing department may have very few instructors who can effectively teach the course. With the limited number of instructors, it is difficult to improve the new curriculum. Consequently, incorporating the new curriculum means that instructors must be ready to use new teaching approaches like simulations, flipped classrooms, and case-based learning. Lack of enough information on these approaches can hinder the adoption of the new curriculum.

Interprofessional collaboration and teamwork are crucial during the curriculum change process. Lack of collaborative efforts may prevent new proposals from sprouting making it difficult to change student learning. For example, some instructors are more lenient to students when it comes to setting learning outcomes. It becomes difficult to agree that students need more because they can easily achieve the set goals. While other instructors can be focused on improving performance, some just want to finish the course and send students to the next class (Fawaz et al., 2018). It becomes difficult to vote for new approaches to instruction due to the division within the faculty. Another potential factor hindering the establishment of the new curriculum is the organizational culture. The institution may have its traditions regarding student teaching and learning that have worked for decades. Changing this culture requires just more than mere presentation of facts to the administration. There should be thorough research on the gap and presentation of evidence that the new approach will improve critical thinking among students.

Change is a process that is perceived differently in any organization. Research establishes that fear for change is among the greatest barriers to implementing new ways of doing things. The critical thinking approach to instruction may be caused by fear of both instructors and students to adopt new learning ways. For example, the nursing curriculum is already stressful and challenging to students and instructors. Adding another approach to student learning may seem like a punishment to the two parties. Adding this curriculum will eventually increase the content that is already overwhelming to the nursing students (Fawaz et al., 2018). Additionally, the increased use of technology may be a factor that pushes students away from active learning. Some might argue that critical thinking might be unnecessary due to advancements in technology including the use of decision-making support systems that provide a complete guide to patient care.

Critical Thinking Module Part 2 for LPN students

Research Findings and Support of Proposal

Challenges facing Nursing Education. Nursing practice in the 21st century is confronted by various demands owing to the increasing number of elderly and critically ill patients. The preparation of students requires more than classroom education because they need to make other choices that cannot be taught using the ‘books’ strategy. More emerging evidence requires the nursing educators to regularly assess curricula and adjust accordingly to ensure adequate preparation of students. One of the key challenges in nursing education today is the alignment of nursing education with the practice environment Fawaz et al., 2018). It is observed that most students find it difficult to deal with patients in clinical areas due to the changing demands of patients and the increased use of technology. More sets of skills including critical thinking and decision -making are required to successfully enable students to provide safe care. In this regard, it is recommended that nursing curricula be revised, and students are introduced to real-life situations to prevent shock upon qualifying.

Continuous curricular modifications are an essential phenomenon in nursing academia to level learning with the rapidly evolving professional practice. Curriculum change is another issue that affects nursing education leading to ineffective delivery of nursing care (Fawaz et al., 2018). There is supportive evidence that curriculum change takes a lot of time and energy from the nurse educators and administrators. For instance, challenges are observed in the incorporation of critical thinking courses into the nursing curriculum. The healthcare environment today calls for nurses that can rapidly make informed decisions using minimum resources available (Sommers, 2018). It has become challenging to adopt the critical thinking modules because of curriculum change difficulties and issues with changing the nursing culture.

Constituents of Critical Thinking. Critical thinking and clinical reasoning are core competencies that are emphasized in nursing education and nursing clinical practice. Papathanasiou et al (2014) define critical thinking as a mental-active process and subtle perception, analysis, synthesis, and evaluation of information collected or derived from observation, experience, reflection, reasoning, or the communication leading to conviction for action. Critical thinking is a crucial element that is described by scholars as the pillar to delivering quality care today. It is a deliberate nonlinear process of collecting, interpreting, analyzing, drawing conclusions about, presenting, and evaluating info that is factual and belief-based, demonstrated by clinical judgment, which includes ethical, diagnostic, and therapeutic dimensions and research (Sommers, 2018). These definitions indicate that critical thinking in nursing should involve skills like analyzing, interpretation, self-regulation, and evaluation.

Clinical instructors are in a better position to analyze the skills of students and improve their critical thinking skills using various approaches. It is established that instructors should spend more time with students rather than using traditional classroom methods that minimize interaction. While utilizing this approach, various strategies are available to determine good critical thinkers. For instance, a student who thinks critically is inquisitive with regard to a wide range of issues. The student tries to find meaning in an array of issues and consults when necessary (Papathanasiou et al, 2014). Secondly, the student is alert to opportunities that require critical thinking and has self-confidence in their reasoning abilities. Demonstration of critical thinking also requires an understanding of others’ opinions and being fair-minded in applying reasoning. Lastly, honesty and being ready to be corrected represent the ability of a student to think critically. While developing the new curriculum, it will be crucial for students to understand these concepts.

Barriers to Critical Thinking for Students. Critical thinking is applied by nurses in the process of solving problems of patients and the decision-making process with creativity to enhance the effect. Recent studies have focused on determining why critical thinking becomes challenging to nursing students. An exploratory descriptive study was conducted to determine nursing students’ perceptions of critical thinking and clinical reasoning (Wong, 2020). Additionally, the study explored the barriers that students face in developing critical thinking and clinical reasoning. This study observed that students acknowledged the importance of critical thinking in healthcare and its role in improving patient outcomes. One of the major barriers to the adoption of the strategy was the classroom environment that provided little knowledge on improving critical thinking skills (Wong, 2020). Secondly, the student-tutor ratios, organizational culture, and attitudes towards active learning were hindrances to critical thinking learning. This research provides information about the areas that can be improved during the module to ensure the effectiveness of the curriculum change.

Strategies For Effective Critical-Thinking Learning. Critical thinking is a process for safe, skillful, and efficient nursing intervention in healthcare. To effectively deliver, learners must be exposed to various resources and approaches to learning that help promotes critical thinking. Based on the constructivist learning theory, active learning is encouraged through the use of methods like case studies, simulation-based learning, cooperative learning, and reciprocal teaching (MacKinnon et al., 2015). For example, in reciprocal learning, a group of two or more students work together and learn to do things differently. For inquiry-based learning, students are observed to create their questions and seek solutions through research. One outstanding strategy that promotes critical thinking is simulation-based learning (Zarifsanaiey et al., 2016). This approach uses real-life situations in the lab to teach students what is expected during their clinical practice. Research establishes that this approach puts more emphasis on clinical reasoning, identity formulation, and shifts focus from covering decontextualized knowledge to situational cognition (MacKinnon et al., 2015). Additionally, the benefits of simulation-based learning include the provision of a safe environment and the build-up of communication skills for learners.

The role of nurse educators in fostering critical thinking is an area that has received attention in the recent past. Critical thinking is not something one learns in the books, but an approach that is dependent on teaching and learning strategies. Peer learning is one approach instructors use to encourage students to work together to develop critical thinking. This approach is usually facilitated through teaching and learning activities such as student-led workshops, study groups, peer-to-peer learning partnerships, and group work (Vuckovic et al., 2019). A recent study was conducted to investigate preceptors’ and nursing students’ experiences of peer learning in a psychiatric context during their clinical education. During the process of learning, knowledge acquisition, provision of supportive relationships, and reflective practices emerged as the key themes (Vuckovic et al., 2019). It was observed that peer learning promoted the learning process and made it easy for students to acquire knowledge that stimulated critical thinking. Therefore, nurse educators must be ready to incorporate teaching strategies like peer learning to improve the critical thinking skills of the students.

One of the most principal keys aims of nursing education is to promote nursing students’ and nurses’ critical thinking. The development of a curriculum that uses effective instructional strategies is one of the approaches to promote critical thinking. Traditionally, nursing education has focused on the use of the lecture method for teaching and preparation of students for the future. Studies have shown that this approach does not necessarily lead to the development of critical thinking because students are not exposed to real-life scenarios (Zarifsanaiey et al., 2016). While some can develop critical thinking skills from reading books, the majority have to be engaged and guided towards the same. A recent study evaluated the use of flipped classroom strategy compared to the traditional lecture method in the development of critical thinking. After a controlled group study, it was observed that students using flipped classroom strategy had higher critical thinking mean scores than their counterparts (Dehghanzadeh & Jafaraghaee, 2018). This research demonstrates that critical thinking can be more achieved when active learning strategies are used in nursing education.

In today’s challenging and highly complex health care settings nurses must be able to think critically. The key to establishing critical thinking lies in nursing education where students are prepared to deal with changing healthcare needs of patients. Nurse educators must reshape education by adopting instructional strategies to equip students with foundational knowledge in critical thinking, creative problem solving and collaboration (Ab Latif & Mat Nor, 2020). Concept mapping is one of the active student-centered learning strategies identified to promote critical thinking among students. The strategy involves the linking of information using diagrammatic relationships among concepts representing subject knowledge. A study conducted by Latif et al (2016) aimed at ascertaining the effectiveness of concept mapping in improving learner critical thinking skills. Using the Rusnani Concept Mapping (RCM) technique, the research established that the approach can be an innovative way to enhance the academic performance of students (Latif et al., 2016). The strategy helps students learn how to organize data, prioritize patient needs, and relate the patient’s illness with nursing interventions.

Critical thinking has been a long-standing interest of scholars, educators, psychologists, and health care professionals. It is a self-regulatory strategy to solving problems that depend on one’s judgment and knowledge of the subject. In an attempt to establish the relationship between critical thinking and learning, Kabeel and Eisa (2016) conducted a study that focused on baccalaureate nursing students. Using the California Critical Thinking Disposition Inventory (CCTDI) tool to measure critical thinking disposition, there was a correlation between learning approaches and the development of critical thinking. The surface learning and deep learning approaches emerged as the key strategies for educators to foster critical thinking among students (Kabeel & Eisa, 2016). The findings from this research are consistent with those from another study that focused on the use of traditional and case-based learning. Upon experimentation, it was established that case-based learning provides a deeper understanding of content and allows the development of critical thinking abilities (Li & Chen, 2019). This evidence suggests that strict instructional designs should be used in healthcare to enable students to improve their clinical performance.

Application of the ADDIE Model Introduction

The model used for this curriculum proposal is the ADDIE (analysis, design, development, implementation, and evaluation) model of instructional design. This model provides a dynamic and flexible guideline for training and performance assessment. The first phase (Analysis) describes the instructional problem, goals, objectives, and the environment learners acquire knowledge. The nurse educators use this phase to assess the learner’s needs and identify key stakeholders that are crucial to the instruction process (Kim et al., 2020). The design phase deals with learning objectives, assessment instruments, exercises, content, subject matter analysis, lesson planning, and media selection. In the development phase, the focus is on validating and developing the learning resources. Feedback from the stakeholders and pilot testing are approaches that make this phase successful (Kim et al., 2020). The implementation phase involves the preparation of the learning environment and putting the new curriculum into action. Training of the learners is necessary especially when new tools and software are used. The last phase involves evaluation, and it assumes the formative and summative formats. The formative evaluation takes the format of the ADDIE process while the summative evaluation consists of tests given to learners including opportunities for feedback.

Analysis Phase

Academic Setting Description. The academic setting observed for this clinical practice experience involves LPN students from Athens Technical College School of Nursing. Of particular interest for this clinical practice experience are LPN students seeking education to provide nursing care services to patients upon completion of the course. The student population in this course are from diverse ethnic backgrounds including African American, Caucasian, or Hispanic. Regarding the knowledge and skills, all learners already have gone through their clinical experiences and are familiar with the patient environment. All students have at least six months of clinical experience making them an ideal selection for the new curriculum. The learning environment for the students involves both traditional classroom and online instruction. To effectively deliver information, the main method involves the use of textbooks and online discussion boards.

Needs Assessment and Gap Analysis Creation Procedures. To successfully integrate the critical thinking module into the nursing curriculum, a literature review was conducted on the importance of critical thinking to improving patient outcomes. Upon meeting with the stakeholders and observation of students, a gap was identified on the adequacy of preparing students to think critically during their clinical practice. It was observed that the traditional classroom teaching offered less information about real-life situations and did not allow students to develop critical thinking. Additionally, having rotations without simulations made it difficult for students to understand how to make quick decisions. During the gap analysis process, a methodical and systematic approach was used to engage key stakeholders and identify the actual problem. For instance, a survey was conducted to assess the students’ critical thinking skills, learning methods, and challenges in the clinical areas. Secondly, collaboration with stakeholders was done to identify the gap and propose changes to achieve the desired outcomes.

Stakeholders

Administration. For successful implementation of change in the institution, it is crucial to involve the faculty to ensure their support is available to anchor the change. The administration has financial interests in the new change, and they will be responsible for coordinating events during the change process. Additionally, involving the administration will hold other stakeholders like the nurse educators accountable.

Nurse Educators. The role of nurse educators in the gap analysis is to provide insight into the implementation of the curriculum. Their expertise is crucial in identifying problems faced by students during their clinical practice and solutions to the observed critical thinking challenge. The curriculum change also affects the nurse educators directly because they are involved in the instruction, implementation, and evaluation of students. Their input can be crucial to the success of the new change.

Learners. One of the identified barriers to curriculum change is the failure of the learners to adjust to new learning ways. During curriculum change, involving learners ensures that they get to present their problems and recommend approaches like new learning techniques that can improve their performance. These individuals helped to identify the gap in critical thinking and guided the setting of objectives.

Refer to Table2. Curriculum Need-Gap Analysis Table.

Current and Desired Curriculum. The current curriculum that needs to be addressed is the LPN nursing curriculum that provides less room for students to learn critical thinking. According to the syllabus analysis, there is no single unit that addresses critical thinking and the learning strategies used do not allow the students to develop the skill. For instance, most instructors use traditional classroom teaching and only provide textbooks as reference materials. The desired curriculum involves the integration of a short critical thinking module to students to enable the learning of skills and approaches to thinking critically. Secondly, the proposed curriculum intends to incorporate new learning strategies like standardized simulations to expose the students to real-life situations.

Curriculum Changes. The curriculum change will help students develop knowledge on critical and creative thinking. The proposal will help students to learn how to overcome challenges in dealing with patients, respond to emergencies, and communicating with patients. The first approach to the new curriculum will involve the use of standardized simulations to enable students to learn how to deal with patients and make sound judgments. A review of literature supports this strategy because it allows students more time to learn skills needed for effective critical thinking during clinical practice (MacKinnon et al., 2015, Zarifsanaiey et al., 2016). Secondly, the instructors will utilize a variety of learning methods including role-play, flipped classrooms, case studies, and concept mapping to improve the thinking abilities of students. A consensus reached by the curriculum development committee supports the use of these approaches because they will allow active participation of students in learning.  Additionally, studies demonstrate that strategies like case-based learning improve self-confidence among students that allows critical thinking during routine patient care (Li et al., 2019). Upon completion of this module and utilization of other learning strategies, students will be able to think critically and make decisions based on their understanding.

Organizational Strengths and Weaknesses. During the collaboration with stakeholders, a force-field analysis and evaluation of organizational strengths and weaknesses was done to identify the state of the organization in adopting the new curriculum. The first force pushing the formulation of the new curricula is the formation of a standardized course curriculum. The standardized curricula will allow students to learn critical thinking and utilize various learning strategies that can improve their decision-making process (Fernando & Marikar, 2017). Standardized course curricula can be leveraged as an advantage toward the adoption of the critical thinking module because the overall structure of nursing curriculum in the institution has been positively impacted. Soon, every course in the department will be required to demonstrate the promotion of critical thinking using active learning strategies.

Secondly, the use of evidence-based learning in nursing pushes for the promotion of critical thinking to achieve higher cognitive functioning for students (Papathanasiou et al., 2014). The increasing need for the delivery of quality services in healthcare calls for critical thinking. This force can be leveraged as an advantage towards the development of the critical thinking module because the institution has already laid infrastructure to support evidence-based practice in nursing education. The availability of simulation labs, and purchase of technology to guide student learning is an added advantage to the adoption of the critical thinking course into the nursing curriculum.

Some forces may impede the integration of critical thinking into the current curriculum. For instance, some instructors have lenient and sub-standard learning outcomes that do not challenge the students. Secondly, the LPN curriculum is already overstretched, and given the limited study period, instructors might find it challenging to use the new learning strategies effectively (Fawaz et al., 2018). Most of these strategies, especially simulation labs and case studies alongside concept mapping take a lot of time that is unavailable. The time required for effective implementation and evaluation of the new curricula is a hindrance to the adoption of the new strategy. The negative impact of these factors could be mitigated by procuring an outside resource like the Lippincott Solutions that contains best-in-class suite of evidence-based modules for nursing education including those for critical thinking. Another action that can be helpful is the appointment of one curriculum development master to oversee the entire project while allowing other nurse educators to focus on their primary duties.

There are a few organizational strengths and weaknesses that are likely to affect the adoption of the new curriculum. Firstly, good collaborative relationships between faculty members will promote timely review of the current curriculum and designing of the desired one. Secondly, the organization’s readiness for change and strong leadership will ensure the new change is adopted and supported throughout. Lastly, the organization has a good reputation and is ranked nationally among the best institutions offering nursing training. This reputation will influence the adoption of the new curriculum that will see an increase in overall student performance. One weakness identified is the lack of enough budgeting for curriculum instruction and change for the nursing department. This means it will take a lot of adjustments before the new change is approved by the administration.

Design Phase

Syllabus Creation Procedures. Independent and collaborative procedures were followed to improve the existing course syllabus. Based on the need gap analysis, I reflected on the content that should be included in the syllabus to achieve the desired outcomes. The reflection helped me to create the student outcomes and course objectives that could guide learners towards achieving critical thinking. The second step involved a review of the course materials and the incorporation of new items that could foster student learning. I reviewed the drafted objectives and used Bloom’s taxonomy to create clear and measurable objectives. I reviewed the literature to determine the student needs, teaching strategies, and learning materials that could provide more support to the new curriculum. Lastly, I reflected upon the syllabus by asking a few questions. ‘How can I engage students? How will the new approach foster critical thinking? What resources do students need? ‘These questions helped me develop a collaborative approach towards the creation of the new module.

Collaborative procedures during the creation of the course mainly involved the course instructor and other stakeholders. I used emails and direct phone calls to engage the course instructor where we discussed the relevance of the new approach to critical thinking. The instructor was able to recommend more resources, refine the course objectives and connect me with other faculty members relevant to the LPN curriculum. Using the zoom meeting approach, I presented my proposal and received feedback appropriately. The input of these stakeholders led to further modification of the syllabus and the creation of a final draft that was submitted to the course instructor.

Refer to Appendix A: Course Syllabus

Course Description. As a nurse educator, it is important to cultivate a compelling course description that provides learners with an accurate outline of its contents, so learners are well informed of the expectations and requirements of the course. The goal of the critical thinking module incorporated into the LPN curriculum is to increase the critical thinking skills of students and enable decision-making during patient care. A new student will interpret the course description by understanding that it deals with critical thinking for nursing students. The student will be able to observe that learners will use different approaches like case studies, flipped classrooms, and simulations to broaden their understanding of the course. Additionally, the new student will understand how the course will benefit the learner through the improvement of their critical thinking, creativity, and decision making.

Refer to Appendix A: Course syllabus: Overview.

Course Objectives. Effective course objectives need to be observable and measurable, and using action verbs is one way to achieve this. The course objectives provided in the syllabus used Bloom’s taxonomy action verbs that highlighted what was required of the learner upon completion of the course. For example, the first objective is to describe coping skills when communicating with patients. The student at this level will be able to analyze different skills that can be used when establishing communication relationships with patients. Another objective is for the student to explain the role of healthcare professionals in interpreting information to patients including terminologies. This objective exposes the student to think that patients need to understand terminologies and communication should prevail when using medical terminologies.

Refer to Appendix A: Course Syllabus: Objectives

Teaching Strategies, Instructional Delivery Methods, and Learning Materials. The approach used to develop teaching strategies, instructional methods, and learning materials is well supported by evidence and theory. The course syllabus describes the use of teaching strategies like case-based learning, simulations, concept mapping, and role-playing. These strategies are observed to increase the student’s ability to learn and think critically. For instance, Dehghanzadeh and Jafaraghaee (2018) describe the use of flipped classrooms to foster student engagement and discussions that improve their critical thinking abilities. Simulation-based learning is another approach that is well-supported by evidence to improve critical thinking and decision-making (MacKinnon et al., 2015). Additionally, the constructivist learning theory recommends the use of these strategies because they demonstrate active learning that improves critical thinking.

Instructional delivery methods described in the syllabus include the use of face-to-face learning, role-play, team-based learning via discussions and online discussions. These approaches are supported by the constructivist theory that recommends interactive learning. The methods demonstrate the interaction between learners, instructors, and different environments that promote critical thinking. Regarding the learning materials, journal articles, course textbooks, case studies, and online videos are available to guide the learner towards achieving the expected outcomes. Research demonstrates that active learning should incorporate different methods and use a variety of resources that give students an option to choose (Kabeel and Eisa, 2016). The use of these materials will add up to individual student experiences that will modify their ability to handle different situations in healthcare.

Refer to Appendix A: Course Syllabus: Teaching strategies, Learning Materials.

Student Learning Outcome Analysis. One of the student learning outcomes is that upon completion of the course the student should be able to “Describe three coping skills when communicating with patients including the use of empathy.” This outcome is an example of Bloom’s taxonomy cognitive level of knowledge. It is expected that the student performance level of the SLO will be able to successfully summarize skills for communicating with patients including how empathy can be applied in routine patient care. To measure this outcome, the student will be given a case scenario and asked to analyze skills that can be used to effectively communicate with the patient. Additionally, the student will explain how empathy can be applied in the presented case scenario. This student learning outcome aligns with the course objectives because it deals with therapeutic communication and the use of different skills while communicating with patients.

Refer to Appendix A: Course Syllabus: Student Learning Outcomes

Course and Grading Policies. The course and grading policies will support the new approach to the LPN curriculum to ensure that all students adhere to the required standards. Such policies include classroom participation, professionalism, and preparedness. These policies will ensure that the student actively participates in the learning process to achieve critical thinking upon completion of the course. The grading policies indicate the criteria for pass/fail that determine the ability of the student to learn. For example, a score of 80% and above will indicate the student passed the course. This score will be a collective of performed assessments and end-of-semester exams that are based on the course objectives. Additionally, students will be required to participate in classroom discussions and reply to peers in online discussion posts to pass the course.

Development Phase

Course Material Creation Procedures. In cultivating the critical thinking course into the LPN program, both independent and collaborative efforts were employed to provide learners with content that could promote development. The independent efforts involved the review of the current curriculum, identification of the gap, identification of current resources, and areas that required improvement. A literature search was then conducted to identify relevant articles that educated critical thinking among nurses using different approaches. The scenario-based learning activities and case studies provided were independently reviewed to ascertain their relevance to the critical thinking module. Upon completion of this review, it was necessary to involve other stakeholders that had more knowledge on the required resources for the course. Emails were used as the primary method of communication where brief information about the chosen methods was given. The stakeholders were encouraged to send any questions and clarify areas that required adjustment. Direct consultation with the course instructor was done to identify gaps in the learning resources and to add more suggestions into the module development.

Learning Resources and Learning Activity. The learning resources utilized in this course include two course textbooks and one journal article. The course textbooks provide detailed information on critical thinking including required skills and techniques. The critical thinking in the nursing textbook offers students an opportunity to understand how different case scenarios are managed using critical thinking approaches. The peer-reviewed journal article provides students with an opportunity to learn how scenario-based activities trigger critical thinking and decision making in healthcare. The presented case scenario in the assessment section will equip students with experience on how to communicate care to patients. Through discussions, students will be able to reflect on similar scenarios when practicing independently.

Formative Assessment. The formative assessment in this course will utilize a five-minute quiz covering the introduction to critical thinking in nursing. Students will answer three questions and present the answers to the instructor for marking. This assessment will measure the student’s understanding of the module, basic skills that facilitate critical thinking, and how it relates to nursing practice. Upon completion of the test, the instructor will understand the student’s listening abilities, mastery of content, and reading abilities. Those who will perform poorly will be encouraged to read routinely, utilize a variety of resources and the instructor can change the teaching methods to ensure understanding of the course.

Please see Appendix C: Formative Assessment

Summative Objective Assessment. The summative objective assessment designed is a 10-multiple choice question test to be completed at the end of the instruction period. The results of this assessment will be used to improve teaching strategies and learning outcomes in other modules. The instructor will look at the pass rates, median, mean, and central tendency to examine how the class did overall. Using the item difficulty index and other statistical analysis methods, the instructor will determine how well the course content was understood and areas that might require attention.

Please see Appendix C: Summative Objective Assessment

 Summative Performance Assessment. This assessment will utilize a scenario-based learning approach followed by discussions. A simulation activity will be organized in the skills lab to prepare students for analyzing situations and making necessary changes during clinical practice. The case-based scenario is relevant to the course proposal because it uses an active learning strategy that has a huge impact on critical thinking development. The simulation will enable the utilization of group discussion that will broaden the student’s minds on what their peers think and how situations can be handled differently. The simulation will help improve collaborative efforts and enhance communication techniques that form a crucial part of critical thinking.

Please see Appendix C: Summative Performance Assessment

Implementation Phase 

Implementation Resources. The human resources that will be required to fully implement the proposal are the key stakeholders. These individuals include the administrators, nurse educators, learners, and the information technology team. The administrators will oversee the new curriculum implementation, provide financial resources and other support mechanisms to staff. The nurse educators will function in the curriculum committee to review the proposal, learn critical thinking instruction, and recommend any changes. The learners will offer a platform through which education will commence and feedback provided during the implementation phase. The financial resources required will include funds to coordinate meetings and curriculum review, and payment for the academic nurse educators teaching the new module.

Pilot Testing Procedures. Upon full implementation of the new course, pilot testing procedures will include defining roles of stakeholders, development of feedback, and refining the course depending on the feedback. Key stakeholders during pilot testing will include the academic nurse educators, learners, and hospital clinical nurse educators. The academic nurse educator will review the pilot test results and ongoing classroom evaluations to determine any changes. Learners will provide feedback on the new course module and how it addresses the critical thinking perspective of learning. The clinical nurse educators will observe students during their rotations to ascertain the demonstration of critical thinking. Feedback provision will follow a questionnaire format given to students and an evaluation plan from the clinical nurse educator. The academic nurse educators will also review the test results from students to highlight areas that require improvement. Lastly, the MSN-Ed capstone student, MSN preceptor, and ANE will utilize the information obtained from the pre-and-posttest, in addition to the surveys to gauge the effectiveness of the new curriculum change. The curriculum development committee will analyze the survey results and recommend changes through the academic nurse educators.

Faculty Training Plan. The training plan to support the course implementation will begin with the selection and formation of a training committee. The committee will consist of the MSN preceptor, academic nurse educators, and external stakeholders from other institutions with well-developed critical thinking in nursing courses. The committee will meet to discuss the areas of training, training materials, and financial support required during training. A final training program will be submitted to the administration for review and stakeholders informed of their roles during the training program. The faculty and curriculum development committee will organize training venues and alert the nursing educators the dates for commencement of training.

Technical Problems to Implementation. Technical problems that may hinder the effective implementation of the course may include interference with online classes due to network problems and regular software updates in the department. In preparation for these difficulties, the IT team will be readily available to guide students and instructors on the most probable ways to continue their learning. Secondly, all upgrades in the department will be carried out on weekends when there is a minimal learning activity in the institution. Availability of a backup system will ensure that learning resources and student information is safely restored upon system malfunction.

Refer to Table 4: Timeline

Evaluation Phase 

Course Performance Metrics Procedures. In the evaluation phase of the ADDIE Model, the newly developed and implemented course module is meticulously scrutinized to assess the overall effectiveness of the pedagogical design. Regarding the course performance metrics, multiple meetings were held to discuss the most appropriate measures of ensuring the success of the course. The key stakeholders voted on the evidence-based key performance indicators and benchmarks which would most accurately depict module appropriateness and relevance to nursing practice. For example, the stakeholders determined that more than 80% of the learners completed the module and 75% of the learners passed the final examination. These metrics were evident of the success of the critical thinking module for LPN students.

End-of-Course Survey Procedures. The key stakeholders’ meeting discussed the end-of-course survey procedures where the Likert scale was found to be the most effective measure. The key areas of the survey included learner satisfaction, utilization of learning materials, presentation of materials by the instructors, and the overall learning experience. Upon voting of the areas to include in the survey, the following metrics were included: instructor performance, learning materials/resources, learning management system/technology, assessments and assignments, social learning/peer collaboration, and overall satisfaction with the course.

Refer to Appendix D: End-of-Course Survey

Survey Question Analysis. The first part of the analysis is the instructor performance that analyzes the way content was delivered to the students. The completed survey will determine whether the instructor was well-prepared for the course and any adjustments needed in the future. The second part will involve an analysis of the learning materials to determine the ease of using them and their relevance to the course. The students will be able to identify if the materials presented had meaningful information and guided them to complete the course. Regarding technology resources, the survey will determine if the available technology enabled the utilization of techniques to improve critical thinking. The assessments and assignments question will determine if course content was covered, or the instructor used questions that were not part of the course outline. Regarding social learning and collaboration, the survey will determine the extent to which the course encouraged peer learning and discussions. Lastly, the overall satisfaction question would analyze if the module met the expectations of the learner.

Formative Evaluation Plan. The formative evaluation plan for the course will involve the evaluation of needs assessment, analysis of implementation, and analysis of the progress of the new curriculum. In the first part, keys stakeholders including the administration, MSN student, nurse educators, IT team, and hospital clinical nurse educators will analyze the course and determine if it meets the national and institutional requirements. The needs assessment evaluation will act as a baseline for subsequent evaluations to determine the extent of meeting the required outcomes. During the implementation analysis stage, the stakeholders will evaluate the effectiveness of learning materials, the precision of instructors, and the participation of students. The identified barriers will be used to continuously monitor the course and make necessary changes. Lastly, the progress analysis evaluation stage will involve aspects of meeting the course objectives, participation of learners, and passing of examinations. Additionally, the satisfaction surveys will be used to determine the progress of the course and the overall performance of the organization.

Conclusion

The increasing complexity of the healthcare environment and demands of patients have put more pressure on nursing education to prepare highly competent nurses. Nursing education has evolved to meet the needs of diverse communities and to assist learners in transforming into better healthcare providers. The purpose of this proposal is to advocate for the incorporation of the critical thinking module into the LPN nursing curriculum. Critical thinking is observed to offer students and providers skills that enable the delivery of safe, efficient, and patient-centered interventions. Additionally, critical thinking combined with creativity can allow nurses to find specific solutions to healthcare problems during critical times that other interventions cannot be accessed.

Providing learners with an engaging, challenging superlative learning experience, that supports their growth as nurses is the goal of any nursing program. The proposal to incorporate the critical thinking module into the LPN course will allow for the preparation of students that are active and confident in their clinical area practice. The proposal will also allow for the incorporation of active learning strategies into the LPN curriculum to break the monotony of the traditional lecture system. To its importance, the new curriculum will improve the student’s classroom and clinical area performance because of active learning interventions. Additionally, the course will ensure the preparation of confident and highly competent nurses that will be able to handle the ever-changing complex healthcare system.

To meet the identified curriculum gap, new insights and approaches to learning were used. Firstly, new learning styles like the use of scenario-based learning, group discussions, and online discussions will be used. A student-centered approach will be used to ensure that learners dictate the learning process and that diverse teaching methods are used to meet the individual needs of the learners. The proposed course is relevant to nursing education because it provides learners with experiential learning that is relevant, evidence-based, and meaningful to their practice. The module exposes students to diverse learning styles that prompt interest in the profession and enable mastery of content. Most importantly, the new approach encourages reflective practice, independence, and the making of sound decisions during nursing care delivery.

 

References

Ab Latif, R., & Mat Nor, M. Z. (2020). Using the ADDIE Model to develop a Rusnani concept mapping guideline for nursing students. The Malaysian Journal of Medical Sciences: MJMS, 27(6), 115–127. https://doi.org/10.21315/mjms2020.27.6.11

American Association of Colleges of Nursing. (2020). ELNEC resources. Retrieved from https://www.aacnnursing.org/ELNEC/Resources

Dehghanzadeh, S., & Jafaraghaee, F. (2018). Comparing the effects of traditional lecture and flipped classroom on nursing students’ critical thinking disposition: A quasi-experimental study. Nurse Education Today, 71, 151–156. https://doi.org/10.1016/j.nedt.2018.09.027

Fawaz, M. A., Hamdan-Mansour, A. M., & Tassi, A. (2018). Challenges facing nursing education in the advanced healthcare environment. International Journal of Africa Nursing Sciences, 9, 105-110. https://doi.org/10.1016/j.ijans.2018.10.005

Fernando, S. Y. J. N., & Marikar, F. M. M. T. (2017). Constructivist teaching/learning theory and participatory teaching methods. Journal of Curriculum and Teaching, 6(1), 110–122. https://doi.org/10.5430/jct.v6n1p110

Kabeel, A. R., & Eisa, S. A. E. M. M. (2016). The correlation of critical thinking disposition and approaches to learning among baccalaureate nursing students. Journal of Education and Practice, 7(32), 91-103. https://www.iiste.org/Journals/index.php/JEP/article/view/34108/35077

Kim, S., Choi, S., Seo, M., Kim, D. R., & Lee, K. (2020). Designing a Clinical Ethics Education Program for Nurses Based on the ADDIE Model. Research and theory for nursing practice, 34(3), 205–222. https://doi.org/10.1891/RTNP-D-19-00135

Latif, R. A., Mohamed, R., Dahlan, A., & Nor, M. Z. M. (2016). Concept mapping as a teaching tool on critical thinking skills and academic performance of diploma nursing students. Education in Medicine Journal, 8(1), 67-74. https://doi.org/10.5959/EIMJ.V8I1.406

Li, S., Ye, X., & Chen, W. (2019). Practice and effectiveness of “nursing case-based learning” course on nursing student’s critical thinking ability: A comparative study. Nurse Education in Practice, 36, 91–96. https://doi.org/10.1016/j.nepr.2019.03.007

MacKinnon, K., Marcellus, L., Rivers, J., Gordon, C., Ryan, M., & Butcher, D. (2015). Student and educator experiences of maternal-child simulation-based learning: A systematic review of qualitative evidence protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(1), 14–26. https://doi.org/10.11124/jbisrir-2015-1694

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: The development of an essential skill for nursing students. Journal of the Society for Medical Informatics of Bosnia & Herzegovina, 22(4), 283–286. https://doi.org/10.5455/aim.2014.22.283-286

Sommers C. L. (2018). Measurement of critical thinking, clinical reasoning, and clinical judgment in culturally diverse nursing students – A literature review. Nurse Education in Practice, 30, 91–100. https://doi.org/10.1016/j.nepr.2018.04.002

Vuckovic, V., Karlsson, K., & Sunnqvist, C. (2019). Preceptors’ and nursing students’ experiences of peer learning in a psychiatric context: A qualitative study. Nurse Education in Practice, 41, N.PAG. https://doi.org/10.1016/j.nepr.2019.102627

Wong, S., & Kowitlawakul, Y. (2020). Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study. Nurse Education Today, 95, 104600. https://doi.org/10.1016/j.nedt.2020.104600

Zarifsanaiey, N., Amini, M., & Saadat, F. (2016). A comparison of educational strategies for the acquisition of nursing student’s performance and critical thinking: Simulation-based training vs. integrated training (simulation and critical thinking strategies). BMC Medical Education, 16(1), 294. https://doi.org/10.1186/s12909-016-0812-0

Table 1

Literature Review Summary Table

First author (Pub Year)	Title	Purpose	Context	Findings	Relevance	Strength of evidence
Vuckovic, 2019	Preceptors’ and nursing students’ experiences of peer learning in a psychiatric context.	Focusing on mental health students’ clinical experiences, this study aimed at seeing if nursing students developed any more critical thinking skills during peer learning with a preceptor.	The population of interest was nursing students during their clinical area experience on mental health. The authors evaluated how the students developed critical thinking when learning took place together with a preceptor.	The findings from the study indicate that peer learning during clinical experience for students and the use of a preceptor promotes the learning process and development of critical thinking skills.	This article is relevant to the proposal of teaching critical thinking to LPN students because it highlights the importance involving preceptors during clinical experience to foster critical thinking.	Level VI, Qualitative study Strengths: The study emphasized on the aspect of knowledge acquisition for students during the interactive preceptor learning. More preceptors were available to guide the learning process leading to acquisition of desired skills. Weaknesses: The study population was too minimal to produce reliable results as demonstrated (11 students and 17 preceptors).
Papathanasiou, 2014	Critical thinking: The development of an essential skill for nursing students.	The study aimed at presenting the basic skills of critical thinking, to highlight critical thinking as an essential skill for nursing education and a fundamental skill for decision making in nursing practice.	The study addressed four main areas including introduction to critical thinking, critical thinking skills for students, enhancement behavior of the skills and critical thinking implementation in nursing practice.	The findings from the study indicate that the main critical thinking skills for students include critical analysis, distinguishing facts and opinions, clarification of concepts and recognition of conditions.	This study is relevant to my proposal because it highlights the crucial critical thinking approaches and skills that can facilitate the success of the new curriculum.	Level V, Meta-synthesis Strengths: The study comprehensively describes the key critical thinking skills required for students and the process of implementation in nursing practice. Weaknesses: The study did not discuss success rates of implementing critical thinking into nursing practice.
Dehghanzadeh, 2018	Comparing the effects of traditional lecture and flipped classroom on nursing students’ critical thinking disposition.	The focus of the study was to compare the effects of the traditional lecture method and the flipped classroom method on critical thinking disposition to students.	The study was conducted in Iran whereby 85 students were grouped into two. Random allocation of the two student classes to the lecture and flipped classroom methods was done.	The study findings showed an improved mean score of critical thinking disposition and its engagement when flipped classroom method was used compared to the lecture method.	This study is relevant to the curriculum proposal because it helps determine the teaching methods that can be incorporated to ensure critical thinking is improved among LPN students.	Level III, Quasi-experimental Strengths: The study used two different groups and two different approaches to demonstrate the results achieved. Weaknesses: The study was only done in a single facility and only 85 students were involved. The study population cannot be used was small to enable generalization of the findings.
Wong, 2020	Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students.	The aim of the study was to explore the perceptions of students towards critical thinking and clinical reasoning while identifying barriers to achieving this outcome.	The population of interest was nursing students from a university in Singapore. An interview was conducted to 20 nursing students using semi-structured questions.	The findings indicate that nursing students perceived critical thinking and clinical reasoning as essential for nursing practices. Additionally, strategies like simulation, case studies, and real clinical experience stimulated critical thinking for the students.	This study is relevant to my proposal because it deals with nursing students and identifies strategies that can be used to improve critical thinking among students.	Level VI, Qualitative study Strengths: Sufficient detail is provided about the student’s perception and methods to improve critical thinking. Weaknesses: Only 20 students from a single institution were used in the study.
Ab Latif, 2020	Using the ADDIE model to develop a Rusnani concept mapping guideline for nursing students.	The aim of the study was to develop an instructional strategy for nurse educators using Rusnani concept mapping (RCM).	A mixed study approach involving nursing students and instructors was used to test the RCM method.	The findings from the study demonstrate that the RCM strategy has high reliability and validity when used to incorporate critical thinking skills into students.	This study is relevant to the proposal because it provides a strategy for instructors to teach critical thinking using the concept mapping approach.	Level IV, Mixed method design (Quantitative and Qualitative study design). Strengths: The study demonstrates the use of a new instrument using pre-test and post-test strategies to improve critical thinking among students. Weaknesses: The study did not provide success rates of the RCM strategy from other studies leaving a gap for more research on this item.
Latif, 2016	Concept mapping as a teaching tool on critical thinking skills and academic performance of diploma nursing students.	The purpose of the research was to highlight the importance of concept mapping as a strategy for educators to teach critical thinking to students.	The population of focus was diploma nursing students. The study stressed on the importance of critical thinking, advantages of concept mapping and how concept maps can be used to promote critical thinking in nursing.	The researchers discussed how educators need to move lessons towards simulation and active learning styles rather than memorization. Concept mapping is an effective strategy to improve critical thinking among nursing students.	This study is relevant to the proposal because it supports the role of educators towards the student’s utilization of critical thinking. It supports concept mapping strategy that will be included in the curriculum to improve critical thinking among LPN students.	Level VII, Expert opinion Strengths: Sufficient data is found to support the use of concept mapping as a teaching method during critical thinking improvement. Weaknesses: The article is just an expert opinion that presents facts from other studies.
MacKinnon, 2015	Student and educator experiences of maternal-child simulation-based learning.	The purpose of the study was to identify meaningfulness of maternal-child simulation to inform curriculum decision- making	The population of focus was undergraduate nursing students from Canada. The systematic review involved a literature search from CINAHL, Medline, Academic Search Complete and Web of Science databases.	The study found the maternal-child simulation-based learning approach to be effective in improving decision-making among nursing students. There was demonstration of improved critical thinking and decision making, especially on recognition of deteriorating patent conditions.	This research is relevant to my proposal because it uses the simulation approach to improve skills among nursing students. The simulation approach is observed to improve critical thinking and decision-making among students.	Level I, Systematic review Strengths: The research utilizes numerous articles from an array of databases to support the use of simulation learning. Weaknesses: There were no systematic reviews of qualitative studies indicating the use of maternal-child simulation-based learning for undergraduate students.
Kabeel, 2016	The correlation of critical thinking disposition and approaches to learning among baccalaureate nursing students.	The aim of the research was to determine the relation between critical thinking dispositions and learning approaches among baccalaureate nursing students.	The population of focus was nursing students. 120 students were selected for the study where the California Critical Thinking Disposition Inventory (CCTDI) tool was used to measure the dimensions of critical thinking.	The research found that there were positive correlations between critical thinking disposition and approaches to learning among baccalaureate nursing students.	This article supports my proposal as it provides a guide to instructors on how they can encourage and motivate students towards achieving deeper meaning in nursing. Assessment of learning approaches are necessary for teachers to truly determine extent of instruction that generates and encourages critical thinking.	Level IV, Descriptive-correlational design. Strengths: The study provides evidence from numerous literatures on critical thinking disposition. Weaknesses: The study was conducted in a single institution and only 120 students were enrolled.
Sommers, 2018	Measurement of critical thinking, clinical reasoning, and clinical judgment in culturally diverse nursing students.	The purpose of the study was to look at critical thinking, clinical reasoning, and clinical judgment among different students and how culture affected these outcomes.	The population of focus was nursing students from different cultures. Data was collected from databases of databases of PubMed, CINAHL, ERIC, PsychINFO, and ProQuest with limitations to articles published between 2010 and 2016.	The results indicated that students from the Asian culture scored low on critical thinking with students from western cultures found to learn more using hands on strategies. Consequently, the Eastern cultures were observed to be used to lectures for learning.	This study is relevant to my proposal because it demonstrates the use of different learning approaches to enable critical thinking, clinical reasoning and decision making in healthcare.	Level I, Meta-analysis Strengths: The study utilized numerous literature from different databases. The incorporation of multiple cultures makes the findings appropriate for diverse student populations.   Weaknesses: Some studies included in the analysis were low on the level of evidence scale.
Li, 2019	Practice and effectiveness of “nursing case-based learning” course on nursing student’s critical thinking ability.	The focus of the paper was to explore the effect of “nursing case-based learning” course on the critical thinking ability of nursing student.	The focus population were junior nursing students. During the study, 80 students were selected and divided into the study and control groups. The critical thinking disposition inventory (CTDI-CV) tool was used to evaluate the effectiveness of the educational approaches used.	The results from the study indicated a higher critical thinking ability for the study group compared to the control group. The case-based learning strategy proved to be effective in improving critical thinking skills among nursing students.	This article is relevant to my proposal because it incorporates a new teaching approach (case-based learning) that can be used to improve critical thinking among LPN students.	Level III, Quasi Experimental design Strengths: The inclusion of study and control group gives the research supported evidence of the intervention used. Weaknesses: At the end of the second semesters, the students were assigned to a different hospital to participate in clinical. Additionally, too many external factors impeded exploration of the long-term effects of the intervention on the critical thinking abilities of students.
Zarifsanaiey, 2016	A comparison of educational strategies for the acquisition of nursing student’s performance and critical thinking: simulation-based training vs. integ9rated training (simulation and critical thinking strategies).	The study’s main objective was to compare the performance level and critical thinking ability of nursing students using the approaches of integrated training and simulation-based training.	The population of focus involve students studying practical nursing principles and skills course. 40 students were selected and divided into two groups whereby the two strategies were implemented for either group.	The results from the study indicated that the student’s critical thinking skills improved when the integrated approach (simulation and critical thinking strategies) was used over the simulation approach.	This article is relevant to my proposal because it highlights two crucial approaches that can be used to teach critical thinking. It provides an array of strategies that the instructor can use to achieve better results regarding critical thinking among nursing students.	Level III, Quasi Experimental. Strengths: The reliability of the results are high because different tools were used to analyze the test results. Weaknesses: A small sample size (40 students) from one institution was used for the research and the study was only conducted for a small period of time.

 

 

 

Table 2                                                                                          

Curriculum Need-Gap Analysis Table

Instructional objectives	Current curriculum	Desired curriculum	Need-gap	Action steps to meet the need-gap
Throughout this module, students will be able to: 1. Demonstrate the ability to recognize both deductive and inductive arguments in nursing practice. 2. Describe the steps of the nursing process as an inquiry method during critical thinking application. 3. Analyze coping skills when communicating with patients across all age groups. 4. Identify language problems like ambiguity and vagueness that hinder therapeutic communication in healthcare. 5. Use appropriate research in the analysis, construction, and evaluation of arguments.	Textbooks are the only available course and reference materials. The traditional classroom teaching and clinical area learning are the dominant instruction methods. Lack of student-centered learning approaches. Passive teaching methods that do not engage students. Lack of critical thinking module for LPN course.	A curriculum that will teach students strategies to think critically in relation to nursing practice. A curriculum that will utilize student-centered learning using methods like simulations and case studies. A curriculum that will engage students and encourage collaborative practice to develop critical thinking skills.	Nursing students must be prepared with critical thinking skills to effectively manage patients in today’s complex healthcare environment. Teaching students in class does not necessarily lead to critical thinking; more approaches that engage students are required to bring about critical thinking.	1. Create a proposal to incorporate critical thinking module into the current LPN curriculum. 2. Submit the proposal to the faculty chair. 3. Engage key stakeholders to discuss the proposal. 4. Make necessary adjustments to the proposal and submit final report to the curriculum master. 5. Train instructors on the new approach and introduce the curriculum to the LPN students.

 

 

Table 3

Organizational Readiness for Curriculum Proposal

Forces FOR Curriculum Proposal		Curriculum Proposal		Forces AGAINST Curriculum Proposal
Standardized and streamlined curriculum		Critical Thinking Module for LPN Students.		Overstretched LPN curricula
The use of evidence-based learning				Time and resources for curriculum development
Organizational readiness for change				Time for curriculum review and discussion of changes
Organizational reputation and the need to maintain the reputation				Organizational culture for student learning and instruction
Promotion of critical thinking for the learners				Inappropriate timing of the new change leading to syllabus alteration

 

 

 

Table 4

Timeline

Task to be Completed	Accomplished Date	Responsible Stakeholders
Meeting with stakeholders to discuss course information, and implementation procedures.	10th June, 2021	Nurse educators, curriculum committee, and the administration.
Discussion of financial, human and time resources for implementation of the course	15th June, 20121	Administration and curriculum committee.
Prepare the training module for nurse educators and email ANEs to attend training.	22nd June, 2021	MSN student, curriculum preceptor
Complete training of nurse educators and provide feedback.	1st July, 2021	MSN student, curriculum instructors and specialists.
Evaluate the course rubrics and the course content design.	15th July, 2021	MSN student, nurse educators and faculty administration.
Actual implementation of the module.	September, 2021	Administration, preceptor, nurse educators, and learners.
End of course surveys	November, 2021	Nurse educators, administration, preceptor, learners.

Diagram 1

Affinity Diagram

Outcomes

Increased students’ performance

Increased critical thinking knowledge

Increased students’ satisfaction with the course

Increased faculty satisfaction with the new module

Safety

Utilization of critical thinking in healthcare

Positive patient experience

Increased ability to practice safely

Students’ Needs

Confidence in dealing with patients

Independence in make decisions

Critical thinking skills in stressful situations

Realistic scenarios during learning

 

Appendix A

Course Syllabus

Course Number:                               Reference Number:                          Term:

Course Title: Critical Thinking in Nursing                           Credit Hours: 3hrs

Instructor Information

Name: (Please utilize email for all communication purposes)

Office Location: (Please utilize email for all communication purposes)

Contact: (Please utilize email for all communication purposes)

Course Description/Overview

This course is designed to help LPN students to develop learning strategies necessary to attain success in the nursing program. The goal of the course is to increase critical thinking skills and prepare the learner to adequately manage today’s complex healthcare system. By the end of the course, all students will be able to apply the nursing process to provide care that is based on critical thinking across all patient populations. Learning strategies will be presented in context for easy applicability and transferability of nursing knowledge. Students will benefit from this course because it will introduce them to complex problems and provide techniques to come up with well-reasoned conclusions and solutions.

Course Objectives

As a result of taking this course, the student will be able to:

1. Apply deductive and inductive reasoning in making clinical judgement when implementing the nursing process.
2. Analyze the steps of the nursing process as an inquiry method during critical thinking application.

• Analyze coping skills when communicating with patients across all age groups.

1. Develop solutions to language problems like ambiguity and vagueness that hinder therapeutic communication in healthcare.
2. Compare appropriate research in the analysis, construction, and evaluation of arguments.

Student Learning Outcomes

Upon successful completion of the module, learners will be able to:

1. Demonstrate the use of critical thinking in handling complex patient situations.
2. Analyze coping skills when communicating with patients including the use of empathy.
3. Apply patient-centered care and therapeutic communication to achieve better patient outcomes.
4. Recognize areas in nursing practice that require critical thinking and prompt decision-making.

Materials- Textbooks and Supplementary Readings

Required Textbook:

Bassham, G., Irwin, W., Nardone, H., & Wallace, J. (2013). Critical thinking: A student’s introduction (5^th ed.). New York, NY: McGraw-Hill.

Supplementary Readings:

Nugent, P. M. & Vitale, B. A. (2012) Test Success: Test Taking Techniques for Beginning Nursing Students (6^th   ed). Philadelphia: F. A. Davis. ISBN: 978-0-8036-2818-2.

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: The development of an essential skill for nursing students. Journal of the Society for Medical Informatics of Bosnia & Herzegovina, 22(4), 283–286. https://doi.org/10.5455/aim.2014.22.283-286

 

Teaching Strategies/Delivery Methods

This course will be taught using the classroom, simulation lab, and online learning environments. The methods of instruction will include:

Lecture                                    Online discussion boards

Small group work                   Role-play simulation

Case-based learning                Concept mapping

Methods of Evaluation: The final grade will consist of the following:

Final examination =60%

Summative objective assessment = 10%

Summative performance assessment = 20%

Online Discussion boards = 10%

Grading Criteria and Scale

90 – 100 = A

83 – 89 = B

75 – 82 = C

Below 75 = F

The minimum score to pass the course is 75%.

Course Policies

Attendance: Attendance is expected for all classes. Make-up assignments may be arranged upon validation of the reasons for missing classes or tests. Late submission of assignments will involve a reduction of 10 points for each day the assignment is late.

Academic Honesty: Students will be required to be honest during their tests and work to protect their work from inappropriate use. Cheating during examination in any form will lead to disqualification from the test. During discussions and submission of assignments, plagiarism is discouraged to the highest degree.

Students with Disabilities: The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights protection for persons with disabilities. Any student with documented disabilities and may require special attention like accommodation should contact the specialized support services.

Appendix B

Course Materials

Course Content

This course will cover the following content:

1. Introduction to critical thinking: Critical thinking skills.
2. Basic inductive and deductive arguments.
3. Levels of critical thinking.
4. Critical thinking competencies in nursing.
5. Critical thinking and the nursing process.

Lecture Content PowerPoint          

Learning Resources

The following resources will be utilized in this course:

Bassham, G., Irwin, W., Nardone, H., & Wallace, J. (2013). Critical thinking: A student’s introduction (5th ed.). New York, NY: McGraw-Hill

Black, B. (2019). Professional nursing E-Book: Concepts & challenges. Elsevier Health Sciences.

Nugent, P. M. & Vitale, B. A. (2012) Test Success: Test Taking Techniques for Beginning Nursing Students (6^th   ed). Philadelphia: F. A. Davis. ISBN: 978-0-8036-2818-2.

Assessments (Done in Appendix C)

Three assessments will be done in this course:

1. Formative assessment
2. Summative performance assessment
3. Summative objective assessment

Appendix C

Assessments

1. Formative Assessment

Instructions: This assessment will utilize a five-minutes quiz to test understanding of introduction to critical thinking in nursing. Please clear your desk of all materials before taking the quiz.

1. Define critical thinking in relation to nursing practice. (3 mks)
2. Identify three critical thinking skills applicable in nursing practice. (3 mks)
3. Explain the commitment level of critical thinking. (3 mks)
4. State three attitudes of critical thinking. (3 mks)
5. Demonstrate how you will use specific critical thinking in clinical practice. (3 mks)
6. Summative Performance Assessment

Overview: The summative performance assessment will utilize a scenario-based learning activity performed in the simulation lab. In this task, the student will assume the provision of end-of-life care to a patient in the clinical setup. Using role-play, group discussions and individual written activity, the student will demonstrate critical thinking in caring for a dying patient.

Instructions: Students will be divided into groups of 5 students to complete a role-play activity followed by a team-based learning session via group discussion and an individually written activity. Each of the three activities will take 15 minutes each and the student will be required to turn in a reflection paper upon completion of the simulation.

Scenario: Nurse A is an LPN orientee working in the medical unit with her preceptor. During the routine rounding they come across Mr. P, a 57-year-old patient admitted last night with breathing difficulties. The family members are present at the bedside and are waiting for communication of the patient’s care. Upon review of tests and imaging, the doctor tells the patient he has end-stage lung cancer. The doctor immediately leaves the room and writes a palliative care consult. Mr. P breaks into tears and appears to be in disbelief saying he is not ready to die.

Role-Play: Assume one of the three roles (nurse, preceptor, or doctor) above and demonstrate how you would have communicated differently to the patient and the family. The skills to display during this activity include therapeutic and empathic communication, active listening. Non-participating students will observe and take notes for feedback during discussions.

Group Discussion: Discuss the communication techniques that helped during the simulation and the nursing interventions that demonstrated critical thinking.

Individual Activity: Write a one-page paper on how critical thinking influences decision making in healthcare. How did you apply critical thinking in the scenario? Support your discussion using one piece of scholarly evidence.

Summative Performance Assessment Rubric

Criteria	Not Evident 0 points	Approaching Competence 1 point	Competent 2 points
Group work participation	The student demonstrates little or no effort in group work during the simulation activity.	The student demonstrates minimal participation in group work during the simulation activity.	The student actively participates in group activity and goes above and beyond expectations during the simulation activity.
Group Work Discussion	A discussion of communication techniques used during the case scenario is not provided. All the provided techniques are vague or do not apply to the case scenario.	The student minimally addressed communication techniques used during the simulation activity. One or more of the provided techniques are vague or do not apply in the provided scenario.	The student actively discussed communication techniques used during the simulation activity. At least three techniques are discussed, and all are relevant to the case scenario.
Critical thinking influence	A description of how critical thinking influences decision-making is not provided. If provided, the submission fails to provide relevant ways critical thinking influences decision-making.	The description provides limited understanding of how critical thinking influences decision-making. The submission addresses only one- or two-ways critical thinking influences decision-making.	The description provides a comprehensive understanding of how critical thinking influences decision-making. The submission adequately discusses three or more ways critical thinking influences decision-making.
Application of critical thinking	A discussion of how critical thinking was applied in the simulation activity is not provided. The submission provides application ways that are irrelevant to the simulation activity.	The discussion illogically explains the application of critical thinking during simulation activity. The submission provides less than two ways critical thinking was applied during the simulation activity.	The discussion comprehensively explains the application of critical thinking during simulation activity. The submission adequately addresses two ways that critical thinking was applied during the simulation activity.
Scholarly sources	A scholarly source with appropriate in-text citation is not provided. The provided source is inappropriate or lacks proper APA in-text citation.	Only one scholarly source is used to support arguments and is correctly cited using the current APA format (APA 7th Ed).	Two scholarly sources are used to support arguments and are correctly cited using the current APA format (APA 7th Ed).

 

 

1. Summative Objective Assessment

Instructions: This objective assessment has a total of 10 multiple choice questions. Students will have 30 minutes to complete the test and only one correct answer will be allowed for each question. The test will be completed in class and no personal items will be allowed during the test. Test results will be available in the next lecture.

1. Summative Assessment Questions
2. Which statement is incorrect about critical thinking?
3. It is used to examine one’s thinking and thinking of others.
4. Maximizes human potential and compensates for problems caused by human nature.
5. It is needed when solving problems and finding solutions.
6. It is a one-time process used to make accurate and appropriate clinical decisions.
7. The aspects of critical thinking include the following EXCEPT.
8. Reflection
9. Experience
10. Language
11. Intuition
12. The levels of critical thinking include the following EXCEPT.
13. Complex
14. Commitment
15. Complete
16. Basic
17. A new graduate nurse utilizing critical thinking understands that.
18. Basic thinking involves trusting that experts have the answer to every problem and situation.
19. Basic thinkers realize that there can be more than one alternative and perhaps the solution.
20. Complex thinkers anticipate patient needs independently.
21. Complex thinkers assume accountability for decisions and evaluate their decisions.
22. Which statement is true about inductive and deductive reasoning during critical thinking?
23. In deductive reasoning, the argument’s truth of its premises guarantees the truth of its conclusions.
24. A deductive argument is one in which the truth of its propositions lends support to the conclusion.
25. Analysis of deductive arguments focuses on their strength or soundness rather than truth of the premises.
26. The key focus in inductive arguments is that it must be impossible for the premises to be true and the conclusion to be false.
27. A client with diarrhea has a physician’s order for bulk laxative daily. However, the nurse does not realize some laxatives can solidify stool and instead concludes ‘The physician does not know the patient has diarrhea.’ This statement is an example of?
28. A fact
29. A judgment
30. An opinion
31. An inference
32. General critical thinking competencies used by nurses include the following EXCEPT?
33. Scientific method
34. Problem-solving
35. Diagnostic reasoning
36. Decision making
37. A patient reports feeling hungry but fails to eat food when served. Using the nursing process approach and critical thinking, the nurse should?
38. Notify the doctor that an NG tube may be needed soon.
39. Believe the patient is not hungry.
40. Assess why the patient is not ingesting the food provided.
41. Leave the food at the bedside until the patient feels hungry enough to eat.
42. While taking care of a patient with breathing difficulties, the nurse elevates the head of the bed. Consequently, the nurse decides to study the amount of sacral pressure occurring to avoid pressure sores. This decision is an example of?
43. Intuition
44. The nursing processes.
45. The scientific method
46. Trial-and-error method

 

10. Match the critical thinking skills in part 1 with their correct explanations in part 2.

Part 1	Part 2
Integrity	A. The thinker follows a systematic approach when making decisions
Humility	B. The individual should be honest, truthful, and willing to accept their mistakes
	C. It is the interest to gain new knowledge
	D. Represents the individual’s ability to accept any limitations in their knowledge and skill

 

Answer Key

1.d                               6.d

2.b                               7.c

3.c                               8.c

4.a                               9.c

5.a                               10.       Integrity- B

Humility-D

 

 

 

 

Appendix D

End-of-Course Survey

The end of course survey will have ten items that will be used to assess the instructor performance, learning materials, learning process, assessments and assignments, collaborative practices, and overall satisfaction with the course module.

Directions: The answers in the survey utilize a Likert scale from 1 to 5. Score 1: strongly disagree, score 2: disagree, score 3: average, score 4: agree, and score 5: strongly agree. Please be honest while answering these questions.

Survey Question	Strongly Disagree 1	Disagree 2	Average 3	Agree 4	Strongly Agree 5
The nurse educator was well-prepared for the course module.
Learning activities were organized and well-facilitated.
Concepts and techniques were effectively presented by the nurse educator.
Learning resources were available, easy to use and relevant to the subject matter.
The learning process followed the course syllabus.
The module encouraged collaboration and critical thinking.
The assignments and assessments were reflective of the course module.
The course module was challenging.
The module improved the ability to think critically.
The course module met my expectations.

 

Please offer a brief comment on the usability of the course content.       …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………