The development and validation of a model for disciplined-thinking in a post-anesthesia care unit
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Nurses caring for patients in the 1990s must be able to critically assess, analyze, diagnose, plan, and deliver care for a variety of patients of high acuity (Reilly & Oermann, 1992; De Young, 1990). Since complex patients have a wide variety of diagnoses and needs, nurses must learn to transfer principles of intervention from one patient scenario to another using a vast body of knowledge and critical thinking skills (Brix, 1993; Simmons, 1993; Snyder, 1993; Bowers & McCarthy, 1993). In short, nurses are expected to deliver expert care based on their ability to think in a disciplined way according to the needs of the patient and the demands of the situation. In an attempt to educate a nurse who can competently meet this challenge, educational reform advocating critical thinking has swept across all levels of curricula in nursing education (Bevis & Watson; 1989, Bowers & McCarthy, 1993; National League for Nursing, 1988). The problem for nursing education and practice is that new curricula changes have been developed and implemented without careful analysis of the relevance of existing critical thinking models to the discipline of nursing. Moreover, no model of thinking specific to the discipline of nursing is being adopted to guide curricula change. The purpose of this inquiry was to identify and categorize discipline specific skills in nursing practice which required disciplined-thinking prior to delivering specific nursing care. From this identification of skills, the researcher designed and tested a model that represents the disciplined thinking skills specific to nursing practice. The theoretical framework drew on principles from general systems theory, cognitive learning theory, and existing critical thinking theory. This study employed both quantitative and qualitative methods for gathering information about disciplined-thinking in nursing. Qualitative data was collected, analyzed, and coded to enhance the proposed Model of Disciplined-Thinking in Nursing Practice. This model created from an expert systems research design was sent to a sample of 485 nurse educators who also were engaged in current nursing practice. Chi-square evaluation of the research hypotheses indicated the respondents found the Model of Disciplined-Thinking in Nursing Practice to be valid, correctly representing the components of Phenomenology and Process, and useful for change in nursing curricula. This inquiry is significant because prior to the development and validation of the Model of Disciplined-Thinking in nursing Practice there was no model of thinking for nursing which was based on empirical data about the critical thinking skills specific to the discipline of nursing. The Model of Disciplined-Thinking in Nursing Practice provides the conceptual foundation from which empirical evidence can be gathered to design educational activities and guide nursing practice.