Article: Nursing Education

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[. . .] Unfortunately for the patient, there is a need to have someone immediately available who has "the ability to collect, interpret, analyze, synthesize, and evaluate data" (Maneval, Filburn, Deringer, & Lum, 2011). Critical thinking is important in nursing primarily because the nurse is the healthcare worker tasked with direct care of the patient (Simpson, 2002, 23). The need to make decisions that will impact the health and safety of the patient is of paramount importance in the role of nurse. Education which fosters this ability is critical to nurses and the literature bears out the fact that multiple methods can be used to accomplish this goal (Maneval, Filburn, Deringer, & Lum, 2011; Reese, Jeffries & Engum, 2010; Simpson, 2002, 26).

Strategies to Enhance Critical Thinking in Saudi Arabian Nursing

In the discussion raised by Simpson (2002) is the difference between critical thinking and other types of mental processes which may, at first, seem to be synonymous. The author indicates that critical thinking is not the same as problem solving, decision making or creative thinking (Simpson, 2002, 23). In problem solving, the nurse is not asked to "raise questions and critique the solutions" (23); decision making differs in that it is only concerned with clinical applications (24); and creative thinking often takes a "leap of faith" approach that is not a function of critical thinking (Simpson, 2002, 25). The importance of critical thinking is that the nurse is able to look at a situation, devise possible solutions to the presented problem, and then he or she can evaluate which possible outcome will be the best when applied to the situation. This level of investigation and thought is being taught in Western nursing programs, and it needs to be integrated into the programs in Saudi Arabia.

A great deal of research has been done regarding different methods of teaching critical thinking in different types of programs, but nursing programs, teaching a specific skill set, have devised singular methods to teach this new skill. Among those are problem-based learning, experiential education/learning, active learning, case study, target teaching, group discussion, student centered teaching, concept matching, and simulations. All of these approaches can be used to instill the concept, but determining which would be best suited for nursing students in Saudi Arabia is the educational conundrum.

Saudi culture is relevant to this discussion because how the native nurses in that country have been taught in the past determines how receptive and successful they will be when attempting to use the instruction while on the job (Simpson, 2002, 115). There is a need for nursing educators to try and understand where the connects and disconnects are for this process to be effective. Critical thinking is a needed application in nursing, so it is critical to determine the most effective pathway for Saudi nursing students.

Simpson (2002) evaluated the use of different types of critical thinking pedagogy and their appropriateness when used in Saudi Arabian nursing programs. Questioning is the technique first implemented by Socrates in his work with students. His aim was to teach a subject by making the students think about the questions that arose when they were considering it. This method has its basis in the eastern tradition and is actually very familiar to students in Saudi Arabia because of its basis in that region of the world (Simpson, 2002, 31). A second method that Simpson (2002, 35) mentions is small group technique. Students are encouraged to look at an issue while in a group and each member is encouraged to think about the problem presented independently. Then all of the students are tasked with coming back to the group with their solution, and all are critically analyzed by all members of the team. This technique has been used by medical and nursing students for many years during clinical training. But, the difference here is that students are asked to think critically and ask questions about the approach presented by other in the group. This method is closely akin to debate which is used in a similar small group setting, and students are asked to look at a number of known solutions to a problem and determine which of them is the best for the situation via lively discussion (Simpson, 2002, 36). Another that Simpson investigated was the use of role-play (Simson, 2002, 37). Students are placed into situations that simulate reality and they are asked to act out what they would do in the given situation. The other nurses in the group are tasked with critically evaluating the responses of the actor to the problem. One of the more interesting critical thinking exercises that Simpson investigated was reflective journaling. She stated that students were asked to journal about their clinical experiences and review their thoughts and actions during a typical day in the hospital. This exercise allowed the students to see what had been done by professional nurses and doctors, and then evaluate it based on the practices that they were being taught (Simpson, 2002, 38).

The methods that Simpson investigated are a part of the different techniques that have been used successfully in Western hospitals. Many revolve around problem-solving exercises, within a group setting, that allows a team of nurses to evaluate each other thought processes. The nurses take the concepts that they have been taught and they determine, via maps or diagrams, what is the best solution for a given problem (Maneval, Filburn, Deringer & Lum, 2011). The success or failure of the various techniques was based on the culture and comfort of the various students in the nursing programs.

Since Saudi Arabia is a country whose primary culture is based around family and a strong central male character, it has been difficult to imbed critical thinking concepts. The nursing students, whether male or female, are reluctant to criticize (Simson, 2002, 199) the doctor (in Saudi Arabia there are very few female doctors, so this may also be a determining factor). The educators task then is to help the Saudi nursing students realize that they are not doing something wrong when they question what a senior nurse or a doctor has said. The educators goal is to use team concepts to prepare the nurses for the profession and the critical thinking that it requires.

Simpson (2002) acknowledged that teaching methods need to reflect the ingrained aspects of both the culture and religion that the students have been taught since birth. The students were reluctant to use any technique that they believed in any way violated their culture. Therefore, instructors need to use techniques that honor the Saudi religion and the family concept. To this end, nursing educators have used techniques that promote team critical thinking techniques (such as group discussion and small group technique) (Reese, Jeffries & Engum, 2010). The research indicated that Saudi nursing students were more comfortable with these techniques because they did not feel that their critique was singled out apart from the group (Reese, Jeffries & Engum, 2010; Simpson, 2002). By utilizing group critical thinking educational approaches, nursing educators should have a great deal of success with Saudi nursing students.

Conclusion

The importance of critical thinking to nursing education has been documented in nursing journals now for more than two decades (Simpson, 2002, 16), but nursing education in some countries has lagged behind those findings. Saudi Arabia, and other Arab speaking countries, are significant test cases for critical thinking theories because the societies are very different from those in the West. Researchers have found that the techniques that work have to be married to the culture and beliefs of the region. By using these findings it may be possible to determine a technique that is specific to Saudi nursing education.

References

Aldossary, A., & Barriball, L. (2008). Healthcare and nursing in Saudi Arabia. International Nursing Review, 55, 125-128.

Almalki, M., Fitzgerald, G., & Clark, M. (2011). The nursing profession in Saudi Arabia: An overview. International Nursing Review, 58, 304-311.

Brown, G. (2006). International nursing department: An up close and personal look at Saudi Arabia (Jeddah and Riyadh) history, culture, and healthcare. ABNF Journal, 16(4), 83-88.

Maneval, R.E., Filburn, M.J., Deringer, S.O., & Lum, G.D. (2011). Concept mapping: Does it improve critical thinking ability in practical nursing students? Nursing Education Perspectives, 32(4), 229-233.

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