The Effects of Reflection on Cognitive Style, Critical Thinking Skills and Thinking Strategies of Nursing Students at Tabriz Medical Sciences University, 2001.

Abstract

Abstract: Introduction: The phenomenon of knowledge explosion has made teachers feel the necessity of training reflective and problem solver students more than ever. The ability of analyzing and evaluation information and making decision is of value for all of the university students, but the importance of such abilities is more for nursing students who are responsible for providing care for patients. Having this in mind, this quasi –experimental study was designed to test out the effects of reflection on nursing students' cognitive style, critical thinking skills and thinking strategies at the faculty of nursing and midwifery in Tabriz University of Medical Sciences. Methods & Materials: All senior students interested in participation (n=40) were divided into 2 equal groups as experimental and control ones. Kolb inventory of cognitive style, California Critical Thinking Skills Test and a scenario designed to elicit students thinking strategies were applied to both groups. Then the two groups had their routine clinical learning experiences but the intervention program offered only to the experimental group. This intervention program consisted of three different parts as follow: A 4 –day workshop on reflection, a 4 –week reflection on practice using dialogue journal writing and a 6 –week reflection on their daily clinical experiences through writing in logs. To evaluate the ongoing process of the intervention program and to gather data at different times (data triangulation), each part of the intervention was evaluated based on the expected outcome. Workshop was evaluated by a questionnaire consisting of open and closed questions. Student's journal writings were also evaluated based on a coding schema on levels of reflection and the logs were evaluated using predefined thinking strategies. Appropriate feedback was provided to the students during the course of intervention. After the completion of intervention (10 weeks), both groups of students took the same tests as the pretest. Results: The results of the study showed no significant difference in cognitive style of the 2 groups despite the fact that the ratio of change in cognitive style of the experimental group was 2 times that of the same change in the control group. The results also revealed that the experimental group significantly differed from the control group in their total scores in critical thinking skills and their inductive reasoning. Furthermore, the experimental group significantly differed from the control group in their total thinking strategy scores and their scores on recognizing pattern, making relationship, providing explanation and making inference. The results of the evaluation of the workshop confirmed the student's satisfaction with content and presentation of provided material during workshop. Analysis of the data obtained from open questions showed that the students had found the positive effects of the workshop on their motivation, self-esteem, and recognition of nursing domain, perception of disciplinary status, thinking, reasoning, judgment and making meaning. Frequency analysis of the data presented in journals showed that the students had revealed different levels of reflection in their journals including: attention to feeling (145), association (276), integration (40), validation (30), appropriation (43) and outcome of reflection (48). Frequency analysis of the data reflected in clinical logs revealed considerable usage of different thinking strategies by students as follows: Recognizing pattern (782) including ascertain complications (410), understanding of treatment protocols (155), distinguishing clinical features characteristics of certain disease conditions (217), forming relationship (886) including understanding the meaning of assessment findings (233) and making sense of the treatment plan (653), generating hypothesis (361) including classification of meaning of assessment finding (140) and speculating about etiology of patient problems (221), providing explanations (743) and drawing conclusions (475). Conclusion: Reflection as a teaching strategy was found to be a successful experience which led to considerable but not significant change in learning styles of students. The experience of reflection positively changed the students' critical thinking skills and their thinking strategies. According to the results of this study, infusion of reflection into the nursing education program is highly recommended. Furthermore, the results of this study may be applied by administrators and directors of nursing education and service to restructure nursing education.