Background: Promoting critical thinking skills is an essential outcome of undergraduate and postgraduate nursing education.

Objectives: The current study aims at comparing critical thinking skills of bachelor students of nursing (BSc) and master’s students

of critical care nursing (MSc) in the academic year 2014 - 2015.

Methods: The current cross-sectional study was conducted on 79 BSc students of nursing and 44 MSc students of critical care nursing

in 3 universities of medical sciences including Semnan, Tehran, and Kashan. The California critical thinking test, form B, was

used for data collection. Analysis of variance Mann-Whitney, and Kruskal-Wallis tests were used for statistical analyses.

Results: Themeanscores of BS and MSc nursing students were 11.14�3.01 and 10.05�3.33, respectively, which were not significantly

different. The mean scores of students in Semnan, Tehran, and Kashan universities of medical sciences were 9.84 � 3.13, 9.66 �

3.32, and 11.79 � 2.92, respectively, and the total mean score was 10.46 � 3.24. The scores of critical thinking domains showed that

students in Kashan University gained higher scores in interference, and deductive and inductive reasoning domains compared with

the students in other universities.

Conclusions: The level of critical thinking in BSc students was higher. The overall level of critical thinking skills was low in nursing

students. It is suggested that appropriate and effective methods should be employed to create and improve critical thinking in

nursing education

Babamohamadi, H.

Emadi, A.

Fakhr-Movahedi, A.

Soleimani, M.

kashan university of medical sciences

Nurs Midwifery Stud. 2017 June; 6(2):e37464.
Published online 2016 December 31.
doi: 10.5812/nmsjournal.37464.
Brief Report
A Comparative Study on Critical Thinking Skills of Bachelor and
Master’s Degree Students in Critical Care Nursing
Hassan Babamohamadi,1 Ali Fakhr-Movahedi,1 Mohsen Soleimani,1 and Alireza Emadi2,*
1Nursing Care Research Center, Department of Nursing, Faculty of Nursing and Allied Health, Semnan University of Medical Sciences, Semnan, Iran
2Deputy of Research and Technology, Semnan University of Medical Sciences, Semnan, Iran
*Corresponding author: Alireza Emadi, Deputy of Research and Technology, Semnan University of Medical Sciences, Semnan, Iran. Tel: +98-2333451336, Fax: +98-33448950,
E-mail: are20935@semums.ac.ir
Received 2016 February 27; Revised 2016 December 20; Accepted 2016 December 21.
Abstract
Background: Promoting critical thinking skills is an essential outcome of undergraduate and postgraduate nursing education.
Objectives: The current study aims at comparing critical thinking skills of bachelor students of nursing (BSc) and master’s students
of critical care nursing (MSc) in the academic year 2014 - 2015.
Methods: The current cross-sectional study was conducted on 79 BSc students of nursing and 44 MSc students of critical care nurs-
ing in 3 universities of medical sciences including Semnan, Tehran, and Kashan. The California critical thinking test, form B, was
used for data collection. Analysis of variance Mann-Whitney, and Kruskal-Wallis tests were used for statistical analyses.
Results: The mean scores of BS and MSc nursing students were 11.14± 3.01 and 10.05± 3.33, respectively, which were not significantly
different. The mean scores of students in Semnan, Tehran, and Kashan universities of medical sciences were 9.84 ± 3.13, 9.66 ±
3.32, and 11.79± 2.92, respectively, and the total mean score was 10.46± 3.24. The scores of critical thinking domains showed that
students in Kashan University gained higher scores in interference, and deductive and inductive reasoning domains compared with
the students in other universities.
Conclusions: The level of critical thinking in BSc students was higher. The overall level of critical thinking skills was low in nursing
students. It is suggested that appropriate and effective methods should be employed to create and improve critical thinking in
nursing education.
Keywords: Critical Thinking, Nursing Students, Education, Nursing
1. Background
Critical Thinking (CT) is one of the thinking styles that
plays a major role in training and education (1, 2).
Although studies highlight the importance of CT as a
fundamental tool in learning, the ability of students to use
CT skills is low (3-10).
Many studies show improving levels of CT over the aca-
demic year (7, 11). However, Hariri and Bagherinezhad re-
ported a low level of all CT domains in BSc and MSc stu-
dents of the faculty of health sciences, Mazandaran Uni-
versity of Medical Sciences (12). As the students proceed
through the academic year and increase their academic
knowledge, it is expected that they become more educated
critical thinkers. However, in adequate data is available re-
garding the CT levels in MSc students of nursing, especially
in the students of critical care nursing who work in com-
plicated and sensitive settings which require taking right
decisions.
2. Objectives
The current study aims at comparing CT skill levels be-
tween the students of BSc and MSc in critical care nursing.
3. Methods
The current cross-sectional study was conducted on 123
nursing students, consisting of 79 BSc nursing students
and 44 MSc students of critical care nursing, from Semnan,
Tehran, and Kashan Universities of Medical Sciences, in the
academic year 2014 - 2015. Inclusion criteria were studying
in the last semester of nursing course, MSc students of crit-
ical care nursing in various semesters, voluntary participa-
tion in the study, and not have taken the California critical
thinking test before the study. Participation in the CT work-
shop or test was considered as an exclusion criterion. Cen-
sus sampling method was used, and a total of 180 question-
naires were distributed among all BSc and MSc students of
critical care nursing.
The California critical thinking test, form B (CCTST, FB)
was used. This test comprises 34 multiple-choice ques-
tions, and a correct answer on 5 domains of critical think-
Copyright © 2016, Kashan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial
4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the
original work is properly cited.
Babamohamadi H et al.
ing (analysis, inference, evaluation, deduction, and induc-
tion) was used to measure the level of CT skills in students.
The time required to answer the test was 45 minutes.
The mean score of the CCTST, FB was 15.89. Accordingly,
scores less than 15.89 indicate lower levels of CT skill and
scores higher than 15.89 represent higher levels of CT skill
(13).
The validity and reliability of the test have been con-
firmed in earlier studies (12, 13). Based on Cronbach’s alpha,
reliability of the test was 0.87.
Three research assistants from the aforementioned
universities were trained on how to fill out the question-
naires. After obtaining permission from the authorities
of the universities, the questionnaires were distributed
among the selected students during the breaks between
classes. All students were asked to respond to the question-
naires in a private environment, and return the filled ques-
tionnaires on the same day.
3.1. Ethical Considerations
The study was approved by the ethics committee
of Semnan University of Medical Sciences (ethic code:
92/358995, 2013/10/23). The objectives of the study were ex-
plained to the respondents and the informed consent was
obtained from all of them before distributing the ques-
tionnaires. The questionnaires were anonymous and the
respondents were assured of data confidentiality.
3.2. Data Analysis
After checking the normality using the Kolmogorov–S-
mirnov test, the data were summarized by descriptive
and analytic statistical methods (ANOVA and the Mann-
Whitney test to compare means; the Kruskal-Wallis test for
non-normal data). Data analysis was performed by SPSS
software version 13.
4. Results
Out of 180 students, 123 ones completed and returned
the questionnaires, 43 of them were from Semnan Univer-
sity (24 BSc and 19 MSc students), 41 from Tehran University
(30 BSc and 11 MSc students) and 39 from Kashan University
(25 BSc and 14 MSc students); 59.3% of the participants were
20 - 24 years old, 65.9% were female, 68.3% were single, and
grade point average of 53.7% of the participants ranged 17 -
18.99.
The mean ± standard deviation (SD) of CT scores for
BSc and MSc students were 11.14± 3.01 and 10.05± 3.33, re-
spectively. The Mann-Whitney test did not show a signifi-
cant difference between mean scores of the 2 groups (P =
0.086) (Table 1).
Table 1. Comparison of Critical Thinking Scores Based on the Level of Education
Degreea
Critical
Thinking
Domains
Bachelor of
Nursing
Master of
Nursing
P-Value
Mean± SD Mean± SD
Analytic 3.25± 1.33 2.70± 1.46 0.064b
Inference 3.59± 1.60 3.25± 1.37 0.312b
Evaluation 4.27± 1.63 4.03± 1.83 0.485
Deductive
reasoning
4.54± 1.67 4.10± 1.92 0.214b
Inductive
reasoning
5.45± 1.76 5.10± 1.92 0.552
Total 11.14± 3.01 10.05± 3.33 0.086
aAll data are presented as mean± SD
bThe Mann-Whitney test (P < 0.05)
The mean± SD of overall CT scores of Semnan, Tehran,
and Kashan universities were 9.84± 3.13, 9.66± 3.32, and
11.79± 2.92, respectively; the total score was 10.46± 3.24.
Comparison of mean scores of CT domains showed that
the students of Kashan University got higher scores in do-
mains of inference, deduction, and induction; their over-
all score was higher than those of the two other universi-
ties. The Kruskal-Wallis test showed a significant difference
among the overall scores of the universities (P < 0.05) (Ta-
ble 2).
5. Discussion
More than two-thirds of the participants obtained
scores lower than the average level of CT, which indicated
poor CT skills. Other studies have also confirmed that
students obtained low scores in one of the CT domains
(8, 12). It is believed that Iranian educational system is
mostly focused on enhancing and strengthening the mind
and knowledge domains rather than developing thinking
skills, criticism, and scrutiny. Although nurses are trained
to think critically, they do not apply it in solving problems;
however, nursing schools have not succeeded in train-
ing the problem-solving process and the right decision-
making skills (14).
The findings of the present study showed that BSc stu-
dents of nursing scored higher compared to MSc students,
although the difference was not significant. It confirmed
that CT should be taught both in the formal university ed-
ucation and the implicit curriculum. In other words, hid-
den curriculum, which plays a critical role in universities,
might help to expand and develop CT skills in BSc students
(10).
2 Nurs Midwifery Stud. 2017; 6(2):e37464.
Babamohamadi H et al.
Table 2. Comparison of Critical Thinking Scores Based on the University
Target University (Mean± SD) Comparative Universities (Mean± SD) P-Value
Analytica
Tehran (2.57± 1.53) Semnan (2.92± 1.24) 0.264
Kashan (3.23± 1.47) 0.059
Kashan (3.23± 1.47) Semnan (2.92± 1.24) 0.337
Tehran (2.57± 1.53) 0.059
Inferencea
Semnan (3.14± 1.55) Kashan (4.05± 1.33) 0.014
Tehran (2.92± 1.26) 0.470
Tehran (2.92± 1.26) Semnan (3.14± 1.55) 0.47
Kashan (4.05± 1.33) < 0.001
Kashan (4.05± 1.33) Semnan (3.14± 1.55) 0.014
Tehran (2.92± 1.26) < 0.001
Evaluation
Semnan (3.76± 1.97) Kashan (4.51± 1.44) 0.057
Tehran (2.57± 1.53) 0.353
Tehran (2.57± 1.53) Semnan (3.76± 1.97) 0.353
Kashan (4.51± 1.44) 0.334
Kashan (4.51± 1.44) Semnan (3.76± 1.97) 0.057
Tehran (2.57± 1.53) 0.334
Deductive reasoninga
Semnan (3.85± 1.79) Kashan (4.89± 1.81) 0.011
Tehran (4.07± 1.79) 0.580
Tehran (4.07± 1.79) Semnan (3.85± 1.79) 0.580
Kashan (4.89± 1.81) 0.049
Kashan (4.89± 1.81) Semnan (3.85± 1.79) 0.011
Tehran (4.07± 1.79) 0.049
Inductive reasoning
Semnan (5.05± 1.70) Kashan (5.89± 1.69) 0.041
Tehran (4.73± 2.03) 0.434
Tehran (4.73± 2.03) Semnan (5.05± 1.70) 0.343
Kashan (5.89± 1.69) 0.013
Kashan (5.89± 1.69) Semnan (5.05± 1.70) 0.041
Tehran (4.73± 2.03) 0.013
Total
Semnan (9.84± 3.13) Kashan (11.79± 2.92) 0.007
Tehran (9.66± 3.32) 0.810
Tehran (9.66± 3.32) Semnan (9.84± 3.13) 0.81
Kashan (11.79± 2.92) 0.004
Kashan (11.79± 2.92) Semnan (9.84± 3.13) 0.007
Tehran (9.66± 3.32) 0.004
aKruskal-Wallis test (P < 0.05)
Comparison of CT mean scores, in the three universi-
ties, showed that the scores of Kashan University students
in the domains of inference, deduction, induction, and the
overall CT scores were significantly higher than those of
the students of Tehran and Semnan Universities. This dif-
ference could be attributed to the educational system and
teaching process. It is likely that teachers in Kashan Uni-
versity of Medical Sciences use debate, discussions, ques-
tioning, and problem-based learning methods more than
the two other Universities. Martin et al. reported that tradi-
tional educational strategies such as lecture methods can-
not improve CT abilities and cognitive skills in nursing stu-
Nurs Midwifery Stud. 2017; 6(2):e37464. 3
Babamohamadi H et al.
dents (3).
Overall, the current study showed that the CT mean
scores were low in five domains of the test among the BSc
and MSc students, and the lowest levels were observed in
analytic and inference domains. It is believed that various
interrelated factors can affect the scores, included the fail-
ure of educational system, on memorization of the materi-
als in the classrooms, lack of conceptual learning, and lack
of deep and thoughtful questioning.
The study had several limitations. First, the study was
performed in three universities and had a small sample
size. Second, there may have been a nonresponse bias due
to the 30% dropout. Hence, further studies are needed to
investigate the CT skills in large populations with different
education levels.
Acknowledgments
The current study was conducted with assistance and
cooperation of respectable authorities of Semnan, Tehran,
and Kashan Universities of Medical Sciences; senior nurs-
ing students; and MSc students of critical care nursing. Au-
thors wish to express their gratitude to every one of them.
Footnotes
Authors’ Contribution: Hassan Babamohamadi, study
design and conceptualization, data collection, manuscript
writing, and study supervision; Ali Fakhr Movahedi, data
analysis and interpretation; Mohsen Soleimani, study de-
sign and conceptualization; Alireza Emadi, study design
and manuscript preparation.
Conflict of Interest: There was no conflict of interest in
the study.
Financial Disclosure: None declared.
Funding/Support: None declared.
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4 Nurs Midwifery Stud. 2017; 6(2):e37464.


A Comparative Study on Critical Thinking Skills of Bachelor and Master's Degree Students in Critical Care Nursing

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