ABSTRACT The ability to think critically is considered an essential skill of nursing graduates and competent nursing practice. Yet, the literature reports that teachers are having difficulty teaching for critical thinking and that critical thinking is lacking in new nursing graduates. This research study sought to identify barriers to the implementation of critical thinking teaching strategies by nursing faculty currently teaching in generic baccalaureate programs in Tennessee. Surveys were mailed to 262 nursing faculty; 194 were returned, and 175 were usable. Students' attitudes and expectations represented the single greatest barrier to the implementation of critical thinking teaching strategies, followed by time constraints and the perceived need to teach for content coverage. Recommendations to support and encourage faculty to teach for critical thinking are outlined.
Despite calls for major reform in nursing education programs and the development of students' critical thinking skills as a top priority (1), it is reported that nursing education programs are not adequately preparing nurses for the future (2). Beverly Malone, former president of the American Nurses Association, has stated, "Nurse educators are pretty clear that it will take new skills and learning modules for the 21st century nurse. We know those things, but we haven't moved to implement them yet. We are still in transition" (2, p. 11). > The changing health care environment, coupled with new and expanded practice roles for nurses, has led educators to take a closer look at the content, design, and delivery of nursing curricula. In a recent position statement, the American Association of Colleges of Nursing recommended the development of critical thinking skills as a top priority for baccalaureate nursing programs (3). > Students' critical thinking development has been a requirement for program accreditation since 1992 (4). The National League for Nursing Accreditation Commission requires each undergraduate nursing program to develop its own definition of critical thinking in accordance with its values, mission, and philosophy (5). Program accreditation requires the ongoing assessment of how faculty address the promotion of students' critical thinking skills. Findings from these evaluations are used as feedback data for continuous improvement of the nursing program. However, nursing education programs are having difficulty meeting these accreditation requirements (6).
Review of the Literature A survey of deans and directors of nursing programs, published by O'Sullivan and colleagues in 1997, found that only 20 percent of the undergraduate programs had implemented the critical thinking requirement (6). Moreover, respondents reported difficulty in developing methods to teach critical thinking and found resistance to these changes among faculty. These findings were supported by a Delphi survey of nursing faculty conducted by the National League for Nursing (7). Forty percent of the faculty respondents reported that teaching critical thinking was the area in which they felt least prepared.
There is evidence that the emphasis on critical thinking is not being realized in student outcomes. In a comprehensive study designed to identify entry-level competencies needed by graduates with a bachelor's degree in nursing (BSN), King (8) surveyed 117 nurse educators, 82 nurse administrators, 23 recently graduated BSNs, 96 experienced BSN graduates, and 11 deans/directors of nursing programs. Critical thinking "to solve problems and to make decisions" was listed most frequently as the most important entry-level competency. However, it was ranked among the lowest of observed competencies (8).
In a correlational study, Colucciello (9) sought to determine the critical thinking dispositions of senior-level BSN nursing students. The California Critical Thinking Disposition Inventory, developed by Facione and Facione (10), was used to measure the students' affective dimensions of critical thinking, such as selfconfidence, inquiry, analytic abilities, and open-mindedness. …