Problem-Based Learning Enhancing Critical Thinking Skills ...

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Problem-Based Learning Enhancing Critical Thinking Skills in Nursing StudentsAntoinette McNeil, BSN, RN, CCRNWashington Adventist UniversityTheoretical Foundations of Teaching and Learning in Nursing - HybridNUED 525D. Paxson Barker, PhD, MS, RNJune 27, 2013TABLE OF CONTENTSABSTRACT3INTRODUCTION4BACKGROUND4ANALYSIS OF THEORY9PROS AND CONS11IMPLICATONS FOR NURSING12REFERENCES13AbstractNursing education is about promoting critical thinking, which is a process of reflection which involves more than analyzing facts (Bradshaw & Lowenstein, 2011) .There has been many discussions regarding how best to teach critical thinking to nursing students. Lecturing has been the main teaching method in nursing schools. Since learners today are of the technological era educators are looking for innovated teaching methods that will stimulate thinking and keep students engaged. Problem-based learning (PBL) is a methodology that engages the learners in a vigorous quest to seek data to accurately solve a simulated real-life problem (Neimer, Pfendt, & Gers, 2010). Critical thinking is a skill that nursing students must develop when practicing at the bedside upon completion of their nursing program. Much research has been done on PBL. The question asked is Problem-based learning effective in teaching critical thinking skills to nursing students? Problem-Based Learning Enhancing Critical Thinking Skills in Nursing StudentsCritical thinking skills are a must for nursing students. Curriculums are developed to help nursing students develop critical thinking skills which are vital to their practice. Many classes that are taught in nursing school are lecture based, which many students find non-stimulating. Problem-based learning (PBL) is an innovative method to help medical and nursing students develop critical thinking skills. PBL allows basic science knowledge to be relevant to students’ learning needs by relating it to a clinical problem (Callis et al., 2010). Problem-based learning is an educational process where learning is centered on problems and not discrete subject-related courses (Bradshaw & Lowenstein, 2011). Students who have participated in PBL have found it to be stimulating and enjoyable.In PBL, students are responsible for critical analysis of real-life clinical problems (Neimer et al., 2010). If the PBL environment is well designed then, effective problems will peak the students interest and motivate them to probe for a deeper understanding of the concepts being taught (Neimer et al., 2010). For scenarios to be effective they will require students to make decisions or judgments based on facts, information, logic, and /or rationalization (Neimer et al., 2010).BackgroundProblem-based learning was started in the late 1960s at McMaster University in Ontario, Canada (Badeau, 2010). Howard Barrows developed this self-directed model to improve education in the school of medicine (Badeau, 2010). Problem-based learning was developed to progress medical education by moving from a subject and lecture based curriculum to an interdisciplinary one guided by ‘real-life’ problems (Badeau, 2010). There are five components to PBL and they are: problem-based, student-centered, reiterative, small group and facilitation (Badeau, 2010). Problem-based learning is characterized by small group self directed learning which is facilitated by faculty tutors using well thought-out real-life problems (Badeau, 2010). In 2009 the Institute of Medicine wanted a move from instructor-driven learning methods to student-focused learner driven method (Chunta & Katrancha, 2010). In 2010 the American Nurses Credentialing Center supported an accreditation philosophy which states that learning activities are a component of professional development and should be based on national standards of educational design (Chunta & Katrancha, 2010).Critical thinking has been widely accepted as being associated with the provision of quality care. It has been defined by the American Philosophical Association Project as purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation and deduction and is founded on the conceptual criteria on which judgment is based (Ozturk, Muslu, & Dicle, 2008). Keeping this in mind, developing critical thinking skills in nursing is essential in establishing a scientific foundation for the profession, creating a discipline in which truth is sought and implemented, where the use of theoretical perspectives are increasingly being tested and utilized are important to nursing (Ozturk et al., 2008).Nursing education programs are being pressured today to produce newly licensed nurses who are fully prepared for entry into the clinical practice. The clinical setting is where students learn to apply classroom theory to real-life clinical scenarios and to develop problem-solving and decision-making strategies (critical thinking skills) which will eventually carry over into their professional practice (Carrega & Byrne, 2010). Problem-based learning is an innovative method that is used in the classroom to help nursing students develop critical thinking skills.Problem-based learning is seen as a highly structured and learning-centered teaching method. Problem-based learning features include the following: problems are the starting point for learning; real-life problems are used; thinking must be done in terms of problems and not disciplines; oriented knowledge is acquired; learning is student initiated; and there is an emphasis on group discussions (Lin, Lu, Chung, & Yang, 2010). In PBL tutors are used to help facilitate learning of the students.In PBL self-directed learning (SDL) is a major component of this learning method. Self-directed learning has been defined as a process in which individuals take the initiative with or without the assistance of others, to diagnose their learning needs, create learning goals, identify human and material resources for learning, choose and implement appropriate learning strategies and finally to evaluate learning outcomes (Kocaman, Dicle, & Ugur, 2009). Increasing students’ self-directed learning skills will help them to effectively obtain and use knowledge and help them prepare for their professional careers (Kocaman et al., 2009).Critical thinking is a core competency that has been identified by nursing education that is essential for individuals to become self-directed learners (Badeau, 2010). It has been noted that inductive and deductive thinking are part of the critical thinking process (Badeau, 2010). Teaching and learning strategies that are used to achieve critical thinking are SDL activities, interactive discussions, role playing, PBL, mastery learning, case studies, clinical rounds, journaling and reflective practice groups (Badeau, 2010).It has been determined that a important part of SDL and critical thinking is reflection (Badeau, 2010). The purpose of reflection is to attach understanding and meaning to a nurse’s practice of care and it also challenges nurses to think critically regarding their nursing practice, to identify gap in their practice, and to seek change based on current evidence (Badeau, 2010). Problem-based learning allows the nurse the skills to be reflective and a self-directed practitioner.There are studies exploring the outcomes of PBL curriculums and self-directed learning (SDL) in nursing students. One study looked at self-directed learning readiness (SDLR) of students enrolled in a problem-based curriculum. This particular study was conducted at nursing school in Turkey in which a PBL curriculum had been used in this school for at least 8 years (Kocaman et al., 2009). The PBL curriculum had the following characteristics: PBL was done in groups of 6-8 students and was facilitated by a faculty tutor; the program was divided into a series of 2 week modules with five tutorial session devoted to explore patient scenarios; integrated into each module was communication, ethical issues, critical thinking, assessment, and technical skills; person, health, environment, nursing were major concepts in this curriculum; initially the focus was on health promotion and the role of nursing enhancing health of individuals and as student progressed then the focus was on caring for the ill patient; and finally student evaluation which looked at nursing knowledge and skills, problem solving ability, SDL, and group participation (Kocaman et al., 2009).Ozturk et al., 2008) explored the effect of problem-based and traditional education on senior nursing students’ critical thinking dispositions. This study was also done in Turkey looking at the traditional method of teaching which was lecturing and being noninteractive. This method relied memorization and limited incentive to stimulate student’s thinking process (Ozturk et al., 2008). In the PBL method, students worked with problems that resulted from real-live situations. These students worked in small groups identifying learning goals and engaging in self-study only to return to discuss and apply the new learning (Ozturk et al., 2008). The California critical thinking disposition inventory which was developed by Facione and Facione was used which looked at open-mindedness, analyticity, systematicity, critical thinking and self-confidence, inquisitiveness, and maturity (Ozturk et al., 2008).Yuan, Williams, & Fan, 2008) studied student’s perceptions of the change in critical thinking; the California Critical Thinking Dispositions Inventory (CCTDI), The California Critical Thinking Skills Test (CCTST) and The Watson-Glaser Critical Thinking Appraisal (WGCTA) were used in this study (Yuan, Williams, & Fan, 2008). This study examined the student’s responses regarding truth-seeking, open-mindedness, analyticity, systematicity, confidence, inquisitiveness and maturity (Yuan et al., 2008). The CCTST is standardized multiple choice test that has 34 questions targeting critical thinking skills which include analysis, evaluation, inference, deductive reasoning, and inductive reasoning (Yuan et al., 2008). The other test used was WGCTA which is an assessment tool used to measure the foundation critical thinking skills which include inference, recognition of assumptions, deduction, interpretations and evaluation of arguments (Yuan et al., 2008).Lin et al., 2010 compared the educational results of peer tutor problem-based learning and conventional teaching in nursing ethics education. In this study seniors in the Department of Nursing at Taipei Medical University were used. The peer tutor PBL method was applied and tools used in this study were teaching plans, the nursing ethical discrimination ability scale and the learning satisfaction survey (Lin et al., 2010). Three teaching plans were used for PBL that were formulated by a expert panel of seven and each plan included learning objectives, a clinical case exhibiting ethical dilemmas and guidelines for peer tutors (Lin et al., 2010). This research was divided into three stages and seven steps. Stage I: was the designing the curricula for peer tutor PBL and traditional teaching; designing the nursing ethical discrimination ability scale; and designing the learning satisfaction survey. Stage II: the pre-test completion of the nursing ethical discrimination ability scale was done which the student took before class began and the conduction of the educational intervention. This course was taught over an eight week period which for one group involved lectures followed by question and answer sessions and discussions. The other group was PBL and the groups were small with 7-8 people and each PBL case was discussed and studied for two weeks. The PBL discussions were comprised of the five elements of PBL. Stage III: was the administration of the nursing ethical discrimination ability test and the learning satisfaction survey. Both of these test were administered at the end of the course (Lin et al., 2010).Analysis of TheoryIn the first study described there were significant differences in the mean SDLR scores of nursing student based on their year in the nursing program and would increase at each time point (Kocaman et al., 2009). It was noted that the SDLR mean scores were lower the first year and fourth year scores were higher than other years (Kocaman et al., 2009). Students described how important facilitators were to guiding and support the students’ during the transformation period in becoming effective and satisfied self-directed learners (Kocaman et al., 2009)When the student’s entered their final year the program changed to where they spent the majority of their time in clinical practice and one day/week facilitating discussions on clinical situations of their choosing. With the emphasis on self-responsibility and independence in the clinical practice contributed to increase score of SDLR in student their final year (Kocaman et al., 2009). In the second study that was looked at found that the critical thinking disposition scores were higher in the students enrolled in the PBL model than those were in the traditional model school (Ozturk et al., 2008). When looking at open-mindedness and truth-seeking the PBL students again scored higher than the traditional students but when it came to analyticity, systematicity, inquisitiveness, and self-confidence there wasn’t a difference between the two schools (Ozturk et al., 2008).In the third study looked at revealed that the CCTST and CCTDI that were administered revealed that students critical thinking increased. The students’ critical thinking skills and dispositions increased after using PBL for one year (Yuan et al., 2008). When both PBL and traditional students were enrolled in a two semester course, their pretest revealed there were no differences in their critical thinking but after taking the two semester’s course the PBL students critical thinking was greatly increased over the traditional students (Yuan et al., 2008). However, the WGCTA students at the beginning scores improved but later at the end of the course students who had scores dropped at the end of the program (Yuan et al., 2008). Another test was administered to student and that revealed that PBL improved students’ meta-cognition and problem solving process but not their critical thinking skills (Yuan et al., 2008).The fourth study revealed that there was a significant difference in nursing ethical discrimination ability scores between the PBL and traditional educational groups (Lin et al., 2010). The results of the pre versus the post-intervention test showed a significantly difference from each other between the PBL and the traditional group, which revealed that both groups had been impacted in learning by the respective teaching methods (Lin et al., 2010). The PBL groups scored higher on questions regarding self-motivated learning, moral self cultivation, and understanding of nursing ethics issues, critical thinking and intellectual stimulation (Lin et al., 2010).Students who participated in the PBL experiment expressed a higher satisfaction with self-motivated learning and critical thinking as compared to the traditional learning group (Lin et al., 2010). The traditional method of teaching which is lecturing focuses on conveying facts where as PBL helps to promote self-learning and critical thinking (Lin et al., 2010).Pros and ConsAs a facilitator of learning, one must look at the pros and cons of any innovated teaching methods for learning to determine if it is the best method to teach a concept. When it comes to PBL there are advantages to it such as PBL scenarios encourage communication of nurses by promoting learning and asking questions (Chunta & Katrancha, 2010). Problem-based learning scenarios supports the principle of adult learning and promotes independent, self-directed learning skills that foster critical thinking (Chunta & Katrancha, 2010).The statement that PBL provides a more enjoyable and stimulating learning environment for students as well as faculty is one of the strongest arguments in favor of PBL (Badeau, 2010). Students and faculty had the feeling of being more rewarded and nurtured in PBL than the traditional learning method of lectures (Badeau, 2010). Research reveals that PBL is more effective than the traditional approach due to it facilitates a greater student motivation, breadth of interest, learning satisfaction, confidence with clinical functioning, knowledge achievement and the use of various learning resources and self-directed work (Badeau, 2010). Problem-based learning methodology engages problem-focused self-directed learning providing opportunities for learners to enhance their critical thinking, critical analysis, reflection and problem solving skills (Badeau, 2010)The disadvantages to PBL is that educators have a difficult time letting go of the traditional role of an educator and to encourage learners to play a more active role in their learning (Chunta & Katrancha, 2010). Developing scenarios is time consuming especially if they are to be good real-life scenarios. An educator must be clinically competent in developing scenarios and to be able to facilitate the PBL process (Badeau, 2010).Another disadvantage is the fear that knowledge gaps and reinforcement of wrong information may exist (Badeau, 2010). It is thought that students may not attain a comprehensive knowledge base of the problem or issue being studied (Badeau, 2010).Implication for NursingProblem-based learning does promote students to self-directed, increase open-mindedness and truth-seeking scores. It has been demonstrated that students in PBL curriculums report higher satisfaction with self-motivated learning and critical thinking ability as compared to students in the traditional curriculums (Lin et al., 2010). Problem-based learning works best when students are engaged while working through a case (Wiznia, Korom, Marzuk, Safdieh, & Grafstein, 2012). It is imperative that students prepare to discuss the learning objectives of the case presented, yes it may require work outside of the classroom for the student but it improves and leads to a better understanding and retention of concepts being taught (Wiznia et al., 2012).While research on PBL in nursing education is still in its infancy there is still a need for more research to clarify the effects of PBL on critical thinking development within the nursing educational context (Yuan et al., 2008). More research is needed but the research that is present in the literature reveals that PBL is an innovated method that educators need to take time to learn to that they can be the facilitators of learning that they are.ReferencesBadeau, K. A. (2010, November/December). Problem-Based Learning An Educational Method for Nurses in Clinical Practice. Journal For Nurses in Staff Development, 26(6), 244-249.Bradshaw, M. J., & Lowenstein, A. J. (Eds.). (2011). Innovative Teaching Strategies in Nursing and Related Health Professions (5th ed.) Sudbury, MA: Jones and BartlettCallis, A. N., McCann, A. L., Schneiderman, E. D., Babler, W. J., Lacy, E. S., & Hale, D. S. (2010, October). Application of Basic Science to Clinical Problems: Traditional vs. Hybrid Problem-Based Learning. Journal of Dental Eduation, 74(10), 1113-1124.Carrega, J., & Byrne, M. (2010, September/October). Problem-Based Scenarios to Learn Clinical Teaching Skills. Nurse Educator, 35(5), 208-212.Chunta, K. S., & Katrancha, E. D. (2010). Using Problem-Based Learning in Staff Development: Strategies for Teaching Registered Nurses and New Graduate Nurses. The Journal of Continuing Education in Nursing, 41(12), 557-564.Kocaman, G., Dicle, A., & Ugur, A. (2009, May). A Longitudinal Analysis of the Self-Directed Learning Readiness Level of Nursiing Students Enrolled in a Problem-Based Curriculum. Journal of Nursing Education, 48(5), 286-290.Lin, C., Lu, M., Chung, C., & Yang, C. (2010). A comparison of problem-based learning and conventional teaching in nursing ethics education. Nursing Ethics, 17(3), 373-382.Neimer, L., Pfendt, K., & Gers, M. (2010, March/April). Problem-Based Learning in Nursing Education A Process for Scenario Development. Nurse Educator, 35(2), 69-73.Ozturk, C., Muslu, G. K., & Dicle, A. (2008, July). A comparison of problem-based and traditional education on nursing students’ critical thinking dispostions. Nurse Education Today, 28(5), 627-632.Wiznia, D., Korom, R., Marzuk, P., Safdieh, J., & Grafstein, B. (2012). PBL 2.0: enhancing problem-based learning through increased student participation. Retrieved from , H., Williams, B. A., & Fan, L. (2008, August). A systematic review of selected evidence on developing nursing students’ critical thinking through problem-based learning. Nurse Education Today, 28(6), 657-663. ................
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