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Open Access Dissertation

Date of Award


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First Advisor

Dr. Marilyn Oermann


Critical thinking is a thought process used by nurses for clinical decision making. This descriptive correlational study focused on the relationships among critical thinking, decision making and clinical nursing expertise during a clinical simulation. A mid-range theory was developed from the work of Benner (1984) and Paul (1992). As persons develop clinical expertise from novice to expert level, through acquisition of knowledge and experience, critical thinking is developed and used for clinical decision making. A convenience sample of 149 nursing students, graduate nurses, and expert nurses was selected from nursing programs and health care agencies in the Midwest. Critical thinking was measured with the Elements of Thought Instrument (ETI) and California Critical Thinking Disposition Inventory (CCTDI). A decision score was calculated from the ETI. Findings indicated that composite critical thinking and decision making increased as the level of clinical expertise increased. ANOVA revealed differences in ETI scores (F [2,146] = 13.98, p < .0001) and decision scores (F [2,146] = 25.96, p < .0001) among students, graduates and expert nurses; experts had the highest composite critical thinking and decision making scores consistent with the mid-range Theory of Critical Thinking of Nurses. There was a significant although weak, correlation between the ETI and CCTDI (r = .14, p =.04) indicating that the two instruments likely measured different aspects of critical thinking. Several demographics were related to critical thinking process and decision making including the number of college credits taken, number of years of clinical nursing practice, years of experience in a clinical area, and GPA. As experience and knowledge increased, so did composite critical thinking and decision making. The model was tested with path analysis and the paths of experience to decision making and knowledge to decision making accounted for 85% of the variance. While critical thinking should be taught in nursing programs, high levels of critical thinking and decision making may not be achieved until the student gains knowledge and experience in nursing.