Evaluación del pensamiento crítico en enfermería: construcción de un cuestionario basado en el modelo circular de Alfaro-LeFevre

[cat] El pensament crític és un procés cognitiu que representa la capacitat de reflexionar sobre el propi raonament amb l'objectiu de maximitzar els resultats positius i minimitzar els errors a l'hora de prendre decisions. Un entorn sanitari complex i canviant, amb una major necessitat de cures centrades en el pacient i una pràctica basada en l'evidència, són factors que contribueixen a emfatitzar el pensament crític com a competència inherent a la professió. La capacitat del professional d'infermeria per aconseguir millorar la qualitat de cures depèn, en gran part, de desenvolupar habilitats de pensament crític per millorar la decisió diagnòstica. El pensament crític és un procés que pot ser incorporat durant l'etapa professional, però, segueixen sense resoldre alguns problemes associats a ell: la seva ambigüitat conceptual, la seva complexitat en el mesurament i l'encara poca evidència científica sobre la validesa de determinades estratègies de promoció. A nivell teòric, una de les autores que ha realitzat una major aportació al tema és Alfaro-LeFevre. Aquesta autora va plantejar un model circular de pensament crític de quatre components. Aquest model teòric, però, no ha estat operativitzat. Sovint, la investigació s'ha centrat a analitzar el pensament crític en l'àmbit de la formació universitària. Mentre que les investigacions en l'àmbit assistencial són escasses i amb resultats inconsistents. D'altra banda, no s'han trobat investigacions en l'àmbit nacional que aportin informació sobre propietats mètriques de cap instrument capaç d'explorar els components de pensament crític en infermeres en la seva pràctica clínica. Partint d'aquesta necessitat i amb la idea d'explorar el constructe de pensament crític en la pràctica infermera, la present investigació va tenir per objecte dissenyar i validar un instrument que contemplés els components de pensament crític en infermeres assistencials i poder determinar els factors que poden millorar la seva capacitat i precisió diagnòstiques. A partir del marc teòric d'Alfaro-LeFevre es va dissenyar un instrument per avaluar el pensament crític de les infermeres assistencials d'unitats d'hospitalització, nomenat Cuestionario de Evaluación del Pensamiento Crítico en la Práctica Enfermera (CuPCPE) i es va administrar a una mostra de 339 de infermeres assistencials d'un hospital de tercer nivell de la província de Barcelona, durant els mesos de març i abril de 2015. Posteriorment, es van realitzar les anàlisis de les dades amb proves descriptives, mètriques i de correlació. Els resultats obtinguts van ser acords amb el model teòric, evidenciant que el pensament crític és un concepte multidimensional, i confirmant que pot ser explicat per quatre components. D'altra banda, el CuPCPE va demostrar ser un instrument fiable (a= .96) per mesurar el constructe de pensament crític, a més de presentar bona estabilitat temporal (Coeficient de Correlació Intraclasse de .77). També es va observar que les infermeres assistencials presentaven nivells moderats d'habilitats en pensament crític. Entre d'altres resultats destacables, es va evidenciar que hi havia una relació estadísticament significativa entre habilitats de pensament crític i: l'edat (p <.001); els anys d'experiència laboral (p <.001); la unitat assistencial (p <.001); l'experiència en la mateixa unitat assistencial (p <.001); el torn laboral (p = .001); el tipus de contracte laboral (p <.001); la categoria professional (p <.001); el nivell acadèmic (p <.001); i la formació específica en metodologia infermera (p <.001). No s'ha trobat cap relació estadísticament significativa entre les habilitats de pensament crític i el gènere (p = .306). Els resultats van permetre concloure que el model teòric plantejat per Alfaro-LeFevre per a l'exploració del pensament crític en infermeres en l'àmbit clínic era vàlid i que el pensament crític està relacionat amb determinades variables sociodemogràfiques i professionals. Finalment, els resultats de les propietats psicomètriques de l'CuPCPE recolzen la seva utilitat en l'àmbit clínic i en futures investigacions relacionades amb l'exploració del pensament crític.[eng] Critical thinking is a cognitive process that represents the ability to reflect on own reasoning in order to maximize positive outcomes and minimize mistakes when making decisions. A complex and changing healthcare environment, with a greater need for patient-centered care and evidence-based practice, are contributing factors to emphasize critical thinking as an educational and professional competence. The ability of the nurse in order to improve the quality of care depends, in large part, to develop critical thinking skills to improve diagnostic decision. Critical thinking is a process that can be incorporated during the professional stage, however some issues remain unresolved associated with it, its conceptual ambiguity, complexity measurement and still little scientific evidence on the validity of certain strategies promotion. Theoretically, an author who has made a major contribution to the subject is Alfaro-LeFevre. This author proposed a circular four components critical thinking model. This theoretical model, however, has not been operationalized. Often the research has focused on analyzing the critical thinking in the field of university education. While research in the healthcare field are scarce and inconsistent results. Moreover, they have not found research at the national level to provide information on metric properties of any instrument capable of exploring the components of critical thinking in nurses in their clinical setting. Based on this need, with the idea of exploring the construct of critical thinking in clinical nurses, this research aimed to design and validate an instrument that contemplate the components of critical thinking in care nurses and to determine the factors that can improve their ability and diagnostic accuracy. Based on the theoretical framework Alfaro-LeFevre an instrument was designed to assess critical thinking of nurses care inpatient units, named assessment questionnaire critical thinking in practical nurse (CuPCPE) and administered to a sample of 339 nurses care of a tertiary hospital in the province of Barcelona, during the months of March and April 2015. Subsequently the descriptive metric and correlation analyzes were performed. The results were consistent with the theoretical model, showing that critical thinking is a multidimensional concept, consists of four components. Moreover, the CuPCPE proved to be a reliable instrument (a= .96) to measure the construct of critical thinking, besides presenting good temporal stability (Coefficient of Intraclass Correlation .77). It was also noted that clinical nurses had moderate levels of critical thinking skills.Among other notable results, it was observed that there was a statistically significant relationship between critical thinking skills and: the age (p<.001); b) the years of work experience (p<.001); the care unit (p<.001); the experience the same care unit (p<.001); the work shift (p= .001); the type of employment contract (p <.001); the professional category (p<. 001); the academic level (p<. 001), and the specific training in nursing methodology (p<. 001). No statistically significant relationship between critical thinking skills and gender found (p= .306). The results concluded that the theoretical model proposed by Alfaro-LeFevre for exploration of critical thinking among nurses in clinical settings was valid. It was also concluded that critical thinking is related to certain demographic variables and professional partner. Finally the results of the psychometric properties of CuPCPE support its usefulness in clinical practice and future research related to the exploration of critical thinking

‘My biggest fear is that people will forget about him’: Mothers' emotional transitions after terminating their pregnancy for medical reasons

COVID-19; Diagnòstic prenatal; Avortament eugenèsicCOVID-19; Diagnóstico prenatal; Aborto eugenésicoCOVID-19; Prenatal diagnosis; Eugenic abortionAims and objectives To explore women's emotional responses throughout the process of terminating a pregnancy for medical reasons. Background Making the choice to terminate a desired pregnancy for medical reasons has a negative impact on women's health, as it is a distressing process that involves making hard decisions and readjusting one's expectations of an idealised pregnancy. Methods A qualitative phenomenological study was conducted following the COREQ checklist. Fifteen semi-structured interviews and two focus groups were conducted with women who had terminated their pregnancies for medical reasons, previous to and during the COVID-19 lockdown. Subsequently, we analysed the content. Results One main category, emotional journey during the process of terminating the pregnancy, and six subcategories were identified: (I) representation and desire to become a mother, (II) main concerns, (III) impact of the news, (IV) decision-making, (V) emotional responses before termination for medical reasons and (VI) emotional responses after termination for medical reasons. All contributed to understanding the specificities of the different phases that make up the emotional journey of terminating a pregnancy for medical reasons. Conclusions The findings of this study suggest that there are a number of predominant emotions that professionals need to be aware of in order to help women work through them and lessen the impact of pregnancy termination on their mental health. COVID-19 had different connotations depending on the women's experiences. Relevance to clinical practice Our results highlight how important the role of healthcare staff is in caring for these women and their partners, which involves recognising their emotions throughout the process. Our results also underline how useful it is to conduct qualitative studies in this context, since they constitute a set of activities and interventions that result in the administration of nursing care in itself. Patient or Public Contribution The ultimate goal of the action research study is to design a positive mental health intervention. Participants will contribute to the design and final approval of the intervention

The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review

Emocional; Motius mèdics; Interrupció de l'embaràsEmocional; Razones médicas; Interrupción del embarazoEmotional; Medical reasons; Termination of pregnancyBackground In most countries of the world the only basis for considering a termination of pregnancy is for medical reasons. Depending on the circumstances and determinants of each case, the emotional responses to this event vary greatly. The aim of this study is to map the emotional responses of women when their pregnancy is terminated for medical reasons. Methods A scoping review was carried out. This covered all types of qualitative and quantitative studies published in English or Spanish since 2014 which included first-person accounts of women's emotional responses when they had a termination. A bibliographic search was made of four databases (CINAHL, Cochrane Library, PsycINFO and Pubmed) along with an additional manual search and backward and forward citation chaining of the studies included. The data were reported in narrative form and the results grouped according to the descriptive characteristics of the study and the emotions involved. Findings The review process resulted in the inclusion of thirty-four studies. nineteen of these followed a qualitative approach and fifteen used quantitative methodology, with six of them being intervention studies. The emotions found ranged from anxiety and depression to guilt and thankfulness, so various authors stressed the need to improve training for health professionals to provide information, advice and support to the women during the entire process of the termination of pregnancy for medical reasons. Conclusions The available studies cannot be compared given the variety of designs. The predominant emotions underlying the termination for medical reasons were stress, anxiety and depression. Future research should be carried out using samples of participants covering all causes of termination for medical reasons in a particular context so that an intervention can be designed to help lessen the impact of the process on women's mental health.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Autonomy and isolation experienced by patients and primary caregivers during COVID-19 hospitalization in Barcelona (Spain)

SARS-CoV-2; Autonomy; IsolationSARS-CoV-2; Autonomía; AislamientoSARS-CoV-2; Autonomia; AïllamentThis study aims to describe patients' and family caregivers' hospitalization experiences during the COVID-19 pandemic. Using qualitative exploratory descriptive methods, 13 patients admitted to the largest hospital in Barcelona (Spain) due to COVID-19 were interviewed by telephone once discharged, as were eight primary caregivers. Data were analyzed using the content analysis method proposed by Krippendorff. Two main themes were identified: (i) Acceptance of mandatory isolation for patients and family caregivers, which refers to the verbalization of a feeling that justifies the imposed isolation and the need for the use of personal protective equipment by the health team for everyone's safety; and (ii) Limited autonomy during hospitalization for patients and family caregivers, which describes participants' perceptions of autonomy during hospitalization. Patients and caregivers experienced feelings of loneliness, which negatively affected their emotional health. In addition, they experienced reduced autonomy due to new habits and routines intended to control the pandemic for the benefit of public and global health

Adaptação cultural e validação de instrumento sobre habilidades de pensamento crítico em enfermagem

Infermeria; Estudi de validació; Anàlisi factorialEnfermería; Estudio de validación; Análisis factorialNursing; Validation Study; Factor AnalysisObjectives: to validate the Nursing Critical Thinking in Clinical Practice Questionnaire regarding cultural aspects and metric properties. Methods: a methodological research carried out through cross-cultural adaptation, face and content validity, dimensional construct and known groups validity, test-retest reliability and internal consistency. 511 nurses from four hospitals participated in the study, of which 54 participated in retest. Results: the instrument validation for Brazilian Portuguese maintained equivalences, according to the original version. The dimensional validity demonstrated adjustment to the tetrafactorial structure of the original version (GFI=0.69). There were statistically significant differences in critical thinking skills between nurses with graduate degrees and who undertook training, reading articles, developing research and working in an institution with a longer time implementation of the Nursing Process. The instrument showed temporal stability (ICC 073-0.84; p<0.001) and adequate internal consistency (α=0.97). Conclusions: the instrument proved to be valid and reliable for the studied population.Objetivos: realizar la validación del Nursing Critical Thinking in Clinical Practice Questionnaire sobre aspectos culturales y propiedades métricas. Métodos: investigación metodológica realizada a través de adaptación transcultural, validez de rostro y contenido, validez de constructo dimensional y grupos conocidos, confiabilidad test-retest y consistencia interna. En el estudio participaron 511 enfermeras de cuatro hospitales, de las cuales 54 participaron en la nueva prueba. Resultados: la validación del instrumento para portugués brasileño mantuvo las equivalencias, según la versión original. La validez dimensional demostró ajuste a la estructura tetrafactorial de la versión original (GFI=0,69). Hubo diferencias estadísticamente significativas en las habilidades de pensamiento crítico entre enfermeros con posgrados, que completaron su formación, leyendo artículos, desarrollando investigaciones y trabajando en una institución con un tiempo de implementación más largo del Proceso de Enfermería. El instrumento mostró estabilidad temporal (ICC=073-0,84; p<0,001) y adecuada consistencia interna (α=0,97). Conclusiones: el instrumento resultó válido y confiable para la población estudiada.This work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES)

Expectations of patients awaiting lung transplantation: A qualitative study

Expectations; Lung transplant; Patient experienceExpectativas; Trasplante de pulmón; Experiencia del pacienteExpectatives; Trasplantament de pulmó; Experiència del pacientAim The main aim of the present study is to examine the expectations and feelings of people awaiting lung transplantation. Background The assessment of the benefits of lung transplant should consider, among other things, the subjective perceptions of patients about the procedure, especially in relation to the context and to their values, goals and expectations. This is an issue that has not been studied in depth, especially in Spain. Design Exploratory qualitative study. Methods Data were collected through semi-structured interviews during the period of being on the waiting list for transplantation. Thematic analysis of the data was supported by the Atlas.ti software. Results The study population comprised 16 patients awaiting lung transplant, a number sufficient to reach data saturation. Four categories were identified to describe patients' feelings and expectations: (1) reasons for undergoing the transplant, (2) expectations about life post-transplant, (3) emotional state, and (4) relationship with the healthcare team. Conclusions Patients have high expectations of lung transplantation. They see it as offering them a second chance at life, although the future creates uncertainty. The healthcare professionals are identified as key actors, providing essential support and information throughout the various stages of the process. Future research should explore recipients' experiences of lung transplant at later stages. Relevance to clinical practice It is important to adapt care through all the lung transplant process, which is accompanied by intense and complex emotions since the beginning. Thus, providing social and psychological support from the beginning may contribute to their health status, helping them deal with all the emotions and feelings experienced, and find balance between expectations and reality. Patient or public contribution Sixteen patients awaiting lung transplant were interviewed. Interview transcripts were returned to participants to check for accuracy with their experiences

Pensamiento crítico en tutoras de práctica clínica

Objetivo: conceptualizar el estado actual del pensamiento crítico en tutoras académicas y tutoras institucionales en el contexto de la práctica clínica e identificar los instrumentos más utilizados para medir el pensamiento crítico de estas.Método: revisión integrativa para la que se consultaron las bases de datos PubMed y Scopus en el periodo comprendido entre enero de 1998 y marzo de 2022. La búsqueda se efectuó utilizando los términos de lenguaje controlado (critical thinking; mentor; nurse educator; clinical practice; preceptor; Education; Nursing), y artículos publicados en español, inglés y portugués. El proceso de selección de artículos fue asistido con el software Rayyan y descrito con el diagrama de flujo de PRISMA. Se realizó un análisis de contenido de los artículos seleccionados para identificar los temas emergentes. Resultados: se incluyeron 72 artículos originales. 25 eran estudios cualitativos, tres de método mixto, un estudio Delphi, 18 descriptivos, seis cuasi-experimentales, cuatro ensayos clínicos aleatorizados, un estudio analítico, ocho revisiones de la literatura, cuatro estudios correlacionales y una revisión sistemática. Tres fueron las temáticas emergentes: los factores de contexto del pensamiento crítico, las estrategias de promoción y los instrumentos de evaluación del pensamiento crítico. Conclusiones: la profesión enfermera no ha adoptado todavía un estándar para evaluar el pensamiento crítico, esto dificulta el comparar resultados sobre el efecto de determinadas intervenciones relacionadas con el desarrollo del pensamiento crítico

Critical thinking in nursing: scoping review of the literature

This article seeks to analyse the current state of scientific knowledge concerning critical thinking in nursing. The methodology used consisted of a scoping review of the main scientific databases using an applied search strategy. A total of 1518 studies published from January 1999 to June 2013 were identified, of which 90 met the inclusion criteria. The main conclusion drawn is that critical thinking in nursing is experiencing a growing interest in the study of both its concepts and its dimensions, as well as in the development of training strategies to further its development among both students and professionals. Furthermore, the analysis reveals that critical thinking has been investigated principally in the university setting, independent of conceptual models, with a variety of instruments used for its measurement. We recommend (i) the investigation of critical thinking among working professionals, (ii) the designing of evaluative instruments linked to conceptual models and (iii) the identifi- cation of strategies to promote critical thinking in the context of providing nursing car

Development and psychometric properties of the nursing critical thinking in clinical practice questionnaire

Background and aim: A complex healthcare environment, with greater need for care based on the patient and evidence-based practice, are factors that have contributed to the increased need for critical thinking in professional competence. At the theoretical level, Alfaro-LeFevre () put forward a model of critical thinking made up of four components. And although these explain the construct, instruments for their empirical measurement are lacking. The purpose of the study was to develop and validate the psychometric properties of an instrument, the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice), designed to evaluate the critical thinking abilities of nurses in the clinical setting. Methods: A cross-sectional survey design was used. A pool of items was generated for evaluation by a panel of experts who considered their validity for the new instrument, which was finally made up of 109 items. Following this, validation was carried out using a sample of 339 nurses at a hospital in Barcelona, Spain. Reliability was determined by means of internal consistency and test-retest stability over time, although the validity of the construct was assessed by means of confirmatory factor analysis. Results: The content validity index of the N-CT-4 Practice was .85. Cronbach's alpha coefficient for the whole instrument was .96. The intraclass correlation coefficient was .77. Confirmatory factor analysis showed that the instrument was in line with the four-dimensional model proposed by Alfaro-LeFevre (2016). Linking evidence to action: The psychometric properties of theN-CT-4 Practice uphold its potential for use in measuring critical thinking and in future research related with the examination of critical thinking

Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: a multicenter correlation study

Background: In nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context. Objective: To analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates. Methods The study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators' CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P <.05. Results: The total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p=.007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p=.187), with statistically significant differences only observed in the intellectual and cognitive indicator (P =.022). Conclusions: CT levels are high in teaching healthcare professionals in the clinical environment