Iran Journal of Nursing

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Jafari H, Taghavi Larijani T, Ghadirian F, Emamzadeh Ghasemi H. The Association of Competence and Critical Thinking in the Nurses in Imam Khomeini Hospital, Affiliated to Tehran University of Medical Sciences, Iran. IJN 2019; 32 (121) :28-40
URL: http://ijn.iums.ac.ir/article-1-3040-en.html

Background & Aims: The growing sophistication of modern diseases demands a critical level of nursing competence, which could enhance the quality of patient care and patient satisfaction with nurses. Nursing competence is influenced by several factors, such as the clinical environment, work experience, motivation, theoretical knowledge, and personal traits of nurses. In addition, critical thinking could affect the competence of nurses. Critical thinking enables individuals to make decisions and take actions when there are no specific answers, and opposing forces influence decision-making. Critical thinking is a fundamental process for safe, efficient, and skilled nursing in various situations and is also essential to the competence of healthcare professional for the assessment, diagnosis, and effective patient care. Regardless of the correlation of these two variables, competence and critical thinking should be evaluated separately since they are vital to the management, provision, and fulfillment of healthcare services. Therefore, it is possible to ensure the quality of the healthcare services provided to patients by determining the educational needs of nurses and the area that requires improvement. The assessment of these criteria not only assists nurses and managers to be aware of the quality of the competence and critical thinking of nurses, but it also identifies their cognitive deficiencies and weaknesses for their rectification and improvement. Considering the complexity of the assessment of each of the variables of competence and critical thinking and their association in the nurses working in hospitals where many patients with special and complicated conditions refer to, the present study aimed to evaluate the association of competence and critical thinking in the nurses of Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences, Iran.
Materials & Methods: This cross-sectional, descriptive-correlational study was conducted in 2019 on 170 nurses at Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences, who were selected via proportionate stratified sampling. To achieve the research objectives, data were collected using the competency inventory for registered nurses (CIRN) and Ricketts' critical thinking dispositions questionnaire. The inclusion criteria were employment with a bachelor's or higher nursing degree, employment in Imam Khomeini Hospital, work experience of more than one year, no employment in managerial and executive positions, and no apprenticeship. Incomplete questionnaires were excluded from the study. The questionnaires were completed in a self-reported manner. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution, mean, and standard deviation) and analytical statistics, including the analysis of variance (ANOVA), independent t-test, Pearson's correlation-coefficient (r), and Spearman's correlation-coefficient (ρ), Mann-Whitney U test, and Kruskal-Wallis test, at the significance level of 0.05.
Results: The mean age of the nurses (n=170) was 34.38±7.06, and 146 participants (85.9%) were female. The majority of the participants (53.5%) were employed in the public sector and 47.1% had a formal contract. The mean clinical work experience of the nurses was 10.82±6.83 years. In terms of education level, 146 nurses (85.9%) had a bachelor's degree, and the others had a master's degree. The mean total score of competence was 169.74±16.04 (out of 220), which was considered high based on the scoring scale of the instrument. The scores of the subscales of nursing competence were also determined for clinical care (30.18±3.65 out of 40), leadership (27.84±3.24 out of 36), interpersonal communication (24.76±2.57 out of 32), moral/legal performance (25.92±2.43 out of 32), professional progress (18.84±2.33 out of 24), coaching and training (18.51±2.44 out of 24), and willingness for research or critical thinking (23.67±3.19 out of 32). If the scores of the subscales were measured based on four, the maximum and minimum score would be assigned to the subscales of moral/legal performance (3.24±0.30) and willingness for research or critical thinking (2.95±0.39), respectively. The total score of the critical thinking of the nurses was 124.75±12.27 (out of 165), which indicated the high critical thinking performance of the participants. In addition, the scores of the subscales of critical thinking were determined for creativity (27.85±3.28 out of 55), maturity (16.54±3.52 out of 45), and commitment (46.15±5.67 out of 65). A positive, significant correlation was observed between the total scores of nursing competence and critical thinking (r=0.64; P<0.0001). The assessment of the associations of competence and critical thinking with the demographic variables demonstrated no significant correlations between the variables of age, work experience, gender, ward of employment, education level, and employment type with nursing competence. However, the critical thinking of the intensive care unit (ICU) nurses was significantly higher compared to the nurses working in the non-ICU units (P=0.008).
Conclusion: According to the results, the nurses with better critical thinking abilities had superior nursing competence and could provide appropriate and effective nursing care independently. The improvement of critical thinking could positively influence nursing competence. Furthermore, our findings demonstrated that the nurses were not so willing to participate in clinical surveys. Therefore, the healthcare system should be modified for nurses to adapt with evidence-based care studies. Notably, no significant correlation was observed between education level and nursing competence. As education plays a key role in the realization of the clinical competencies of professional nursing, it is expected that with higher education levels, nursing competence would also increase. However, evidence attests to the gap between theoretical and clinical practices, which requires qualitative and in-depth studies to examine the causes of this negative correlation. Furthermore, the impact of various educational systems across the world on the critical thinking and clinical competence of nurses should be addressed in further investigations.