Most nurse educators would agree that critical thinking is an essential competency for the professional nurse in today's ever-changing health care environment. In fact, critical thinking has been identified as an integral component of professional nursing practice and has been incorporated in a result of this imperative, professional programs of nursing must explicate a clear definition of critical thinking, identify specific learning outcomes reflective of critical thinking abilities, and select appropriate ways to measure the achievement of these outcomes in graduating students. Although much has been written about the need for critical thinking skills, the concept and measurement of critical thinking within the context of nursing education has not yet been clearly defined (4-6). As a result, nursing programs are developing their own conceptual definitions of critical thinking and using a variety of methods to measure outcomes (5). * The authors caution that to ensure validity of findings, the instruments used must reflect the individual program's definition of the concept. In most cases, outcomes have been assessed using a cross-sectional design that compares students at different levels or types of programs or are measured as an end-of-program outcome. While such designs can provide educators with knowledge of students' critical thinking abilities at a particular point in the educational process, longitudinal data are needed to assess the effects of the educational program.
This article addresses one program's plan to define, assess, and document critical thinking outcomes of baccalaureate nursing students in a public, urban university in the Northeast with a total enrollment of 12,000 students. The sample consisted of 38 students who began the nursing major in the fall of 1995 and received baccalaureate degrees in the spring of 1997. As part of the nursing program's assessment plan, critical thinking skills and dispositions were measured at program entry and two weeks prior to graduation. The purpose of this descriptive longitudinal study was threefold:
* To measure critical thinking outcome data for baccalaureate students as part of the department's program assessment plan.
* To analyze if differences exist between students' scores at the beginning of the program and at completion.
* To identify the relationship between critical thinking skills and dispositions to variables such as age, grade point average, gender, and ethnicity.
Assessment Measures The validity of findings is strengthened when several methods are used to assess each outcome. Thus, qualitative as well as quantitative methods were used to assess critical thinking in this program; only findings from standardized tests are reported here.
No consensus currently exists regarding the definition and measurement of critical thinking in nursing education. According to Dexter and colleagues (4), nursing literature in this area is mostly at a theoretical and abstract level, which compounds the difficulty in translating concepts to nursing education and actual clinical practice. As a result, "the average, non-specialist educator may well come away with a feeling that critical thinking is sort of a mystical phenomenon that is almost impossible to understand" (p. 165).
This lack of consensus in definition has resulted in the development and use of a wide array of outcome assessment measures, ranging from standardized instruments to less specific forms of measurement. These include course exams, course grades, clinical evaluation tools, journal writing, and NCLEX results.
One of the most widely used commercial instruments for measuring critical thinking in nursing is the Watson-Glaser Critical Thinking Appraisal (WGCTA). Findings from studies using the WGCTA have been inconsistent (7). A review of seven studies that assess critical thinking in nursing students shows no significant changes in CT scores in three studies, a significant increase in three studies, and a decrease in one study. …