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Self-report questionnaires of nurses in Taiwan reveal that critical thinking ability and nursing competence are both at the middle level and there is a correlation between the two
  1. Susan G Forneris
  1. Department of Nursing, St. Catherine University, St. Paul, Minnesota, USA
  1. Correspondence to Susan G Forneris
    Department of Nursing, St. Catherine University, 2004 Randolph Ave, St. Paul, MN 55105, USA; sgforneris{at}

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Implications for practice and research

Concepts such as ‘critical thinking and nursing competence’ are paramount to nursing practice. Chang et al, explore this relationship in practicing nurses. The importance of their work surrounds the positive correlation between critical thinking and nursing competence and the implications for nursing practice:

  • Engage a learner-centred approach;

  • Use the expertise of practicing nurses to guide thinking of novice nurses;

  • Develop nurses' reflective practice.


The complexities of our healthcare environments call for ever increasing professional accountability and decision making of the practicing nurse. Patient outcomes and indicators of quality and safety clearly underscore the demand for high levels of critical thinking and nursing competence.2 Critical thinking is often used synonymously with clinical reasoning, decision-making, judgment – all with varying definitions, theoretical perspectives and research methods. It is important to understand these variations when studying this nursing literature. Tanner3 discusses these differences and outlines important general conclusions about the development of thinking like a nurse that includes the use of context, varied reasoning patterns and reflection on practice. However, Chang et al3 makes an important distinction across these varied concepts suggesting that critical thinking is at the core driving nurses' reasoning process. Critical thinking is also thought to drive nursing competence; however, there is a gap in the nursing literature examining this relationship. This study provides more insight in this regard.


Using a cross-sectional, correlational design the authors compared the relationship between critical thinking and nursing competence using the Watson Glaser Critical Thinking Appraisal (WGCTA) and the Nursing Competence Scale (NCS). Other variables that were compared included age, education level, working years, level of experience using a clinical laddering system categorising nurses as novice, beginner, advanced beginner, etc.


The focus of the study was to determine the nature of the relationship between critical thinking and nursing competence. A total of 570 clinical nurses completed the questionnaires, with ages ranging from 22 to 51 years (mean=31.42, SD 6.77) and majority between 20 and 30 years of age (n=157, 27.5%). Scores of the WGCTA indicated that the critical thinking ability of nurses was at the middle level. Interpretation ability had the highest mean score and inference ability was the lowest mean score. The scores of the NCS indicated that nursing competence was above the middle level for practicing clinical nurses. The study showed a significant positive correlation between critical thinking ability and nursing competence (r=0.32, p=0.001),indicating that the higher the critical thinking ability, the better was the nursing competence. The authors note limitations that include (1) self-assessment of nursing competence that could skew actual levels; (2) use of a convenience sample limiting generalisability.


How nurses are educated and oriented to thinking in practice is an important conclusion supported by this study. Thinking nursing is receiving well-deserved attention in the literature. In their recent book Educating Nurses: A Call for Radical Transformation,4 discuss the need for innovative and transformative strategies that guide nurses in the use of nursing knowledge and science. The depth and breadth of a nurse's understanding within the context of healthcare situations is vitally important to achieving successful patient outcomes. We do know that novice nurses begin their practice using rule-governed behaviour to solve problems and thus are acontextual in their thinking.5 Likewise, (Chang et al1 suggests that regardless of clinical experience, nurses whose education experience was predominantly teacher-centred did not show increases in inferential ability in their critical thinking scores. Interestingly, the level of experience of the majority of these nurses was reported at the novice nurse level with 8.44 mean years of experience. When one considers the critical thinking ability of novice nurses especially during transition to practice, they are just beginning to infer meaning and apply reasoning across contexts.6 7

Nurse educators both in practice and education settings can be more effective in enhancing critical thinking ability through a learner-centred approach guiding thinking through the use of context and dialogue to make that inferential link between thinking and doing.7 The implications for practice and education are clear; engage an active learner centred approach teaching thinking within the context of care. Using the expertise of practicing nurses to share their thinking and clinical reasoning can facilitate both critical thinking and nursing competence. The use of reflective practice to improve practice and transfer learning to new practice situations is essential to enhance patient care outcomes.


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  • Competing interests None.

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