Volume 32, Issue 121 (December 2019)                   IJN 2019, 32(121): 28-40 | Back to browse issues page


XML Persian Abstract Print


1- PhD Candidate in Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2- Associate Professor, Department of Psychiatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: 021-66927171 Email: ttaghavi@tums.ac.ir
3- Assistant Professor, School of Nursing, Khomein University of Medical Sciences, Khomain, Iran
4- Assistant Professor, Department of Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Abstract:   (4105 Views)
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.
Full-Text [PDF 960 kb]   (1557 Downloads)    
Type of Study: Research | Subject: nursing
Received: 2019/09/7 | Accepted: 2019/12/8 | Published: 2019/12/8

References
1. Komeili-Sani M, Etemadi A, Boustani H, Bahreini M, Hakimi A. The relationship between nurses' clinical competency and job stress in Ahvaz university hospital, 2013. Journal of clinical nursing and midwifery. 2015;4(1):39-49.
2. Von Colln-Appling C, Giuliano D. A concept analysis of critical thinking: A guide for nurse educators. Nurse Educ Today. 2017;49:106-9. [DOI:10.1016/j.nedt.2016.11.007] [PMID]
3. Chang MJ, Chang YJ, Kuo SH, Yang YH, Chou FH. Relationships between critical thinking ability and nursing competence in clinical nurses. J Clin Nurs. 2011;20(21‐22):3224-32. [DOI:10.1111/j.1365-2702.2010.03593.x] [PMID]
4. Ghanbari A, Hasandoost F, Lyili EK, Khomeiran RT, Momeni M. Assessing emergency nurses' clinical competency: An exploratory factor analysis study. Iran J Nurs Midwifery Res. 2017;22(4):280-6. [DOI:10.4103/1735-9066.212990] [PMID] [PMCID]
5. Kermansaravi F, Navidian A, Kaykhaei A. Critical thinking dispositions among junior, senior and graduate nursing students in Iran. Procedia Soc Behav Sci. 2013;83:574-9. [DOI:10.1016/j.sbspro.2013.06.109]
6. Ghasemi E, Janani L, Dehghan Nayeri N, Negarandeh R. Psychometric properties of Persian version of the Competency Inventory for Registered Nurse (CIRN). Iran Journal of Nursing. 2014;27(87):1-13. [DOI:10.29252/ijn.27.87.1]
7. Park JA, Kim BJ. Critical Thinking Disposition and Clinical Competence in General Hospital Nurses. J Korean Acad Nurs. 2009;39(6):840-50. [DOI:10.4040/jkan.2009.39.6.840] [PMID]
8. Bifftu BB, Dachew BA, Tadesse Tiruneh B, Mekonnen Kelkay M, Bayu NH. Perceived clinical competence among undergraduate nursing students in the university of Gondar and Bahir Dar university, Northwest Ethiopia: A cross-sectional institution based study. Adv Nurs. 2016;2016:1-7. [DOI:10.1155/2016/9294673]
9. Mohamadirizi S, Kohan S, Shafei F, Mohamadirizi S. The relationship between clinical competence and clinical self-efficacy among nursing and midwifery students. Int J Pediatr. 2015;3(6.2):1117-23.
10. Nehrir B, Vanaki Z, Mokhtari Nouri J, Khademolhosseini SM, Ebadi A. Competency in nursing students: a systematic review. Int J Travel Med Glob Health. 2016;4(1):3-11. [DOI:10.20286/ijtmgh-04013]
11. Karami A, Farokhzadian J, Foroughameri G. Nurses' professional competency and organizational commitment: is it important for human resource management?. PLoS One. 2017;12(11). [DOI:10.1371/journal.pone.0187863] [PMID] [PMCID]
12. Tajvidi M, Hanjani SM. The Relationship Between Critical Thinking and Clinical Competence in Nurses. Strides in Development of Medical Education.;16(1):e80152.
13. Boso CM, Gross JJ. Nurse educators' perceptions of critical thinking in developing countries: Ghana as a case study. Adv Med Educ Pract. 2015;6:555. [DOI:10.2147/AMEP.S88942] [PMID] [PMCID]
14. Pu D, Ni J, Song D, Zhang W, Wang Y, Wu L, Wang X, Wang Y. Influence of critical thinking disposition on the learning efficiency of problem-based learning in undergraduate medical students. BMC medical education. 2019;19(1):1. [DOI:10.1186/s12909-018-1418-5] [PMID] [PMCID]
15. Papathanasiou IV, Kleisiaris CF, Fradelos EC, Kakou K, Kourkouta L. Critical thinking: the development of an essential skill for nursing students. Acta Inform Med. 2014;22(4):283. [DOI:10.5455/aim.2014.22.283-286] [PMID] [PMCID]
16. Jiménez-Gómez MA, Cárdenas-Becerril L, Velásquez-Oyola MB, Carrillo-Pineda M, Barón-Díaz LY. Reflective and critical thinking in nursing curriculum. Rev Lat Am Enfermagem. 2019;27. [DOI:10.1590/1518-8345.2861.3173] [PMID] [PMCID]
17. Carbogim FD, Oliveira LB, Püschel VA. Critical thinking: concept analysis from the perspective of Rodger's evolutionary method of concept analysis. Rev lat Am Enfermagem. 2016;24. [DOI:10.1590/1518-8345.1191.2785] [PMID] [PMCID]
18. Lipe SK, Beasley S. Critical thinking in nursing: a cognitive skills workbook. Lippincott Williams & Wilkins; 2004.
19. Aqtash S, Robb WF, Hunter LH, Almuhtasib M, Hamad A, Brownie SM. Self-assessed competence of experienced expatriate nurses in a rural and remote setting. SAGE Open Nurs. 2017 Apr;3:2377960817702382. [DOI:10.1177/2377960817702382]
20. O'LEARY JE. Comparison of self‐assessed competence and experience among critical care nurses. J Nurs Manag. 2012;20(5):607-14. [DOI:10.1111/j.1365-2834.2012.01394.x] [PMID]
21. Salonen AH, Kaunonen M, Meretoja R, TARKKA MT. Competence profiles of recently registered nurses working in intensive and emergency settings. J Nurs Manag. 2007 Nov;15(8):792-800. [DOI:10.1111/j.1365-2934.2007.00768.x] [PMID]
22. Parsa YZ, Ramezani BF, Khatouni A. Nursing Students'viewpoints about their Clinical Competencies and its Achievement Level. IRANIAN JOURNAL OF NURSING RESEARCH. 2007. 1(3): 7-14.
23. Mahmoud AS, Mohamed HA. Critical Thinking Disposition among Nurses Working in Puplic Hospitals at Port-Said Governorate. Int J Nurs Sci. 2017;4(2):128-34. [DOI:10.1016/j.ijnss.2017.02.006] [PMID] [PMCID]
24. Feng RC, Chen MJ, Chen MC, Pai YC. Critical thinking competence and disposition of clinical nurses in a medical center. J Nurs Res. 2010;18(2):77-87. [DOI:10.1097/JNR.0b013e3181dda6f6] [PMID]
25. May BA, Edell V, Butell S, Doughty J, Langford C. Critical thinking and clinical competence: A study of their relationship in BSN seniors. J Nurs Educ. 1999;38(3):100-10.
26. Bahreini M, Moattari M, Kaveh M, Ahmadi F. Self assessment of the clinical competence of nurses in a major educational hospital of Shiraz University of Medical Sciences. PARS Journal of Medical Sciences (Jahrom Medical Journal(, 2010. 8(1):28-36. [DOI:10.29252/jmj.8.1.28]
27. Liu M, Yin L, Ma E, Lo S, Zeng L. Competency inventory for registered nurses in Macao: instrument validation. J Adv Nurs. 2009;65(4):893-900. [DOI:10.1111/j.1365-2648.2008.04936.x] [PMID]
28. Ricketts JC. The efficacy of leadership development, critical thinking dispositions, and student academic performance on the critical thinking skills of selected youth leaders (Doctoral dissertation, University of Florida). 2003.
29. Hashemabadi G, Garavand H, Mohammadzadeh Ghasr A, Hosseini SA. A survey on relation between tendency to critical thinking and self-directed in nursing and midwifery students and its role on their academic achievement. The Journal of Medical Education and Development. 2013;7(4):15-27.
30. Pakmehr H, Mirdoraghi F, Ghanaei CA, Karami M. Reliability, Validity and Factor Analysis of Ricketts'critical Thinking Disposition Scales in High School. Training Measurement, 2013;4(11):33-53.
31. Soheilipour K, Farajzadeh Z. Evaluating the clinical competence of junior nursing staff based on self-assessmentin Valiasr Hospital of Birjand in 2015-16. Modern Care Journal. 2016;13(4): e10089. [DOI:10.5812/modernc.10089]
32. Meretoja R, Leino‐Kilpi H, Kaira AM. Comparison of nurse competence in different hospital work environments. J Nurs Manag. 2004;12(5):329-36. [DOI:10.1111/j.1365-2834.2004.00422.x] [PMID]
33. Du Mont J, Kosa SD, Solomon S, Macdonald S. Assessment of nurses' competence to care for sexually assaulted trans persons: a survey of Ontario's Sexual Assault/Domestic Violence Treatment Centres. BMJ open. 2019;9(5):e023880. [DOI:10.1136/bmjopen-2018-023880] [PMID] [PMCID]
34. Masoudi R, Etemadifar S. Critical Care Nursing Graduates'perceptions of Factors Affect Clinical Competence: a Content Analysis. Journal of Medical Education Development. 2016. 8(20): 105-13.
35. Blomberg AC, Lindwall L, Bisholt B. Operating theatre nurses' self‐reported clinical competence in perioperative nursing: A mixed method study. Nursing open. 2019;6(4):1510-8. [DOI:10.1002/nop2.352] [PMID] [PMCID]
36. Oyetunde MO, Ofi BA. Nurses' knowledge of legal aspects of nursing practice in Ibadan, Nigeria. J Nurs Educ Pract. 2013 Sep 1;3(9):75. [DOI:10.5430/jnep.v3n9p75]
37. Yazdi Moghaddam H, Mohammadi E. A study to determine the reasons why the results and findings of nursing reseaA study to determine the reasons why the results and findings of nursing research have not been applied effectivelyrch have not been applied effectively. The Horizon of Medical Sciences. 2008;13(4):66-73.
38. Elhami S, Ban M, Mousaviasl S, Zahedi A. Self-Evaluation of Nurses Clinical Competency based on Benner Theory. World Family Medicine Journal: Incorporating the Middle East Journal of Family Medicine. 2018;99(5897):1-7. [DOI:10.5742/MEWFM.2018.93329]
39. Lakanmaa RL, Suominen T, Ritmala-Castrén M, Vahlberg T, Leino-Kilpi H. Basic competence of intensive care unit nurses: cross-sectional survey study. BioMed research international. 2015;2015: 536724. [DOI:10.1155/2015/536724] [PMID] [PMCID]
40. Hicks FD, Merritt SL, Elstein AS. Critical thinking and clinical decision making in critical care nursing: A pilot study. Heart & Lung. 2003;32(3):169-80. [DOI:10.1016/S0147-9563(03)00038-4]
41. Hayes MM, Chatterjee S, Schwartzstein RM. Critical thinking in critical care: five strategies to improve teaching and learning in the intensive care unit. Ann Am Thorac Soc. 2017;14(4):569-75. [DOI:10.1513/AnnalsATS.201612-1009AS] [PMID] [PMCID]
42. Yurdanur D. Critical thinking competence and dispositions among critical care nurses: A descriptive study. International Journal of Caring Sciences. 2016;9(2):489-95

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.