Nurses’ critical thinking disposition and professional commitment: a cross-sectional study
Article Category: Original article
Pubblicato online: 26 mar 2024
Pagine: 119 - 126
Ricevuto: 19 dic 2022
Accettato: 05 feb 2023
DOI: https://doi.org/10.2478/fon-2024-0013
Parole chiave
© 2024 Mahtab Allah Tavakoli et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Nurses’ decision-making requires knowledge and skills to determine the best solution to patients’ problems. They need to think critically about all aspects of problems with an open mind to make correct decisions about care issues.1 Critical thinking is particularly important in the nursing profession because nurses need various types of knowledge in facing different stressful situations.2 Critical thinking consists of skills and attitudes. Skills emphasize cognitive strategies, and the attitudes reflect attitudinal components of thinking and motivation to solve problems.3 Experts have focused more on critical thinking skills, while the attitudinal aspect has received less attention.4 According to Lee et al. (2017), critical thinking is a process of purposeful reflective reasoning in the context of nursing practices through which stakeholders of the care and treatment system examine ideas, assumptions, principles, conclusions, beliefs, and practices.5 In a study, Chen et al. (2022) concluded that caring behaviors were directly and indirectly influenced by nurse’ critical thinking.6
The development of critical thinking has been influenced by various environmental, personal, social, and motivational factors and professional commitment.7 Professional commitment is a socio-environmental factor,8 defined as identification with the profession. This identification includes commitment to the profession, engagement with the profession, and acceptance of the profession’s goals and ethics.9 Professional commitment creates a correlation between personal beliefs and the goals of the nursing profession10 and enhances nurses’ job satisfaction and performance.11 Nursing needs people with a heartfelt desire to maintain a commitment to the profession and strive for its excellence.12,13 In a previous study, researchers found that professional commitment had a direct and significant relationship with job satisfaction.14 Chang et al. (2019) stated that committed individuals believed in professional values and goals and were proud of their profession.10 There is a growing demand among nurses to expand their ability to make effective decisions about patient care. Both critical thinking disposition and professional commitment can have effects on the quality of nursing care. Additionally, critical thinking disposition and professional commitment are associated with the organizational context. Due to the increasing need for nurses to expand their ability to make effective decisions in patient care, they must identify, interpret, and integrate new information and make appropriate decisions. Therefore, the importance of critical thinking and professional commitment in the work of nurses and its impact on patients’ and society’s health is evident. Given the lack of relevant research in Iran, this study aimed at evaluating critical thinking disposition, professional commitment, and the relationship between these 2 variables in nurses.
The present cross-sectional study was carried out in 2 main hospitals in Jiroft, a small city in the southern part of Kerman province in 2019: a general hospital with specialized, general, surgical, and operating room and emergency departments, and a specialized gynecological hospital with gynecology and obstetrics wards.
The study participants included 194 individuals selected from all nurses (N = 388) working in the 2 hospitals at the time of data collection. Considering 5% sample loss, a total of 201 nurses were selected by stratified random sampling according to the number of nurses working in the first (23 of 33) and second (188 of 355) hospitals. Based on the inclusion criteria, nurses with more than 6 months of job experience and a bachelor’s degree or higher could enter the study. Exclusion criterion was having incomplete questionnaires. To perform the stratified random sampling method, both hospitals were considered as classes, the proportional allocation method was applied, and the sample size of each hospital was considered as one class. Later, each hospital was randomly sampled proportional to the number of nurses. After preparing and numbering the list of nurses from each hospital, participants were selected from each hospital according to the table of random numbers.
Data were collected using 3 tools:
A socio-demographic characteristics form was administered to collect information on age, gender, marital status, level of education, type of employment, work experience, shift work, participation in professional commitment training courses, and participation in critical thinking training courses.
Ricketts’s Critical Thinking Disposition Inventory (CTDI) contains 33 items dealing with 3 subscales of Innovativeness (11 item) and Cognitive maturity and Engagement (13 items). In this scale, participants are required to score items on a 5-point Likert scale ranging from strongly disagree (1 score) to strongly agree (5 scores). Negatively worded items (8 items) should be scored reversely.15 The total score of critical thinking disposition was obtained by summing the scores achieved from the 3 subscales (135.31 ≤ 108.91–135.30, and 108.90≥ scores show strong, moderate, and weak critical thinking disposition, respectively).16 Ricketts15 confirmed the reliability of the CTDI by reporting Cronbach’s alpha coefficient of 0.79 for creativity, 0.89 for commitment, 0.75 for maturity, and 0.86 for the whole inventory. In Iran, the reliability of CTDI was calculated as 0.71 using internal consistency.17
Nurses’ Professional Commitment Scale (NPCS) was initially designed by Lachman and Aryana (1986).18 It includes 26 items in the domains of nursing perception (6 items, items 1–6), nursing job satisfaction (4 items, items 7–10), engagement with the nursing profession (6 items, items 11–16), and self-sacrifice for the nursing profession (6 items, items 17–26). The NPCS should be responded based on a 5-point Likert scale ranging from strongly disagree (1 score) to strongly agree (5 scores). The attainable scores can range from 26 to 130, where scores of 26–43, 43–86, and 86–130 indicate low, moderate, and high professional commitment, respectively. The NPCS designers used internal consistency to determine the scale’s reliability and reported a Cronbach’s alpha of 0.86 for the whole scale. In Iran, Shali et al.13 confirmed the validity of the NPCS using the qualitative content validity by a survey of 12 experts and determined its reliability by internal consistency (α = 0.74).
Data were analyzed by SPSS version 21 (IBM Corporation, Armonk, New York, United States) using descriptive (percentage frequency, standard deviation [SD], mean) and analytical (Pearson correlation coefficient, independent
A total of 201 nurses completed the study (response rate = 95.26). According to the findings, most participants were female (74/1%), married (69/7%), and within the age range of 23–40 years. Regarding the type of employment, most nurses were committed (i.e., they should work for the government for 2 years at a lower rate of pay), had a bachelor’s degree, had less than 10 years of work experience, and worked in rotational shifts. Furthermore, more than half of the nurses had a history of attending professional commitment and critical thinking courses (Table 1).
Nurses’ demographic information and its relationship with their critical thinking disposition and professional commitment.
| Variables & groups | n | % | Critical thinking disposition | Professional commitment | ||
|---|---|---|---|---|---|---|
| M ± SD | Statistic test ( |
M ± SD | Statistic test ( |
|||
| 23–40 | 170 | 84.6 | 115.15 (13.82) | 91.23 (12.28) | ||
| □41 | 31 | 15.4 | 118.67 (11.68) | 92.16 (8.56) | ||
| Male | 52 | 25.9 | 113.32 (13.19) | 89.73 (9.19) | ||
| Female | 149 | 74.1 | 116.53 (13.62) | 91.95 (12.52) | ||
| Single | 61 | 30.3 | 111.96 (11.45) | 88.47 (10/69) | ||
| Married | 140 | 69.7 | 117.41 (14.10) | 92.70 (12.04) | ||
| Bachelor | 189 | 94 | 115.68 (13.49) | 91.23 (11.83) | ||
| Master | 12 | 6 | 116.0 (15.11) | 93.66 (9.84) | ||
| F = 0.34 (0.85) | ||||||
| Hired (permanent) | 51 | 25.4 | 119.66 (12.88) | 92.11 (9.84) | ||
| Hired (probationary) | 9 | 4.5 | 115.66 (16.59) | 93.44 (10.98) | ||
| Temporary-to-permanent a | 32 | 15.9 | 115.59 (14.93) | 92.56 (12.71) | ||
| Contract recruiters b | 31 | 15.4 | 115 (13.58) | 90.64 (12.22) | ||
| Committed c | 78 | 38.8 | 113.43 (12.77) | 90.46 (12.60) | ||
| □10 | 147 | 73.1 | 114.89 (13.68) | 91.42 (12.56) | ||
| 11–20 | 34 | 16.9 | 117.44 (13.85) | 89.58 (10.00) | ||
| 21–30 | 20 | 10.0 | 118.65 (11.90) | 94.05 (7.74) | ||
| Fixed | 19 | 9.5 | 117.42 (10.48) | 92.23 (9.58) | ||
| In rotation | 182 | 90.5 | 115.52 (13.84) | 91.28 (11.99) | ||
| Yes | 110 | 54.7 | 119.88 (12.74) | 92.55 (11.93) | ||
| No | 91 | 45.3 | 110.64 (12.82) | 89.95 (11.48) | ||
| Yes | 105 | 52.2 | 118.86 (13/03) | 92.43 (11.74) | ||
| No | 96 | 47.8 | 112.23 (13.32) | 90.21 (11.74) | ||
Annually contracted with payment similar to the hired nurses.
Annually contracted with payment less than the hired nurses.
It is obligatory to work for government for 2 years at a lower rate of pay.
Table 2 shows that the mean scores of nurses’ critical thinking disposition were moderate (115.70 ± 13.55). The highest and lowest mean scores were attributed to the mental engagement (3.68 ± 0.62) and cognitive maturity (3.05 ± 0.56), respectively. The mean score of nurses’ professional commitment was also high (91.37 ± 11.77). The highest mean score was for the engagement with the nursing profession (3.75 ± 0.62), while the lowest mean score was related to the nursing perception (3.19 ± 0.64).
Mean score of nurses’ critical thinking disposition and professional commitment.
| Variable | Minimum | Maximum | Mean ± SD | M ± SD per item |
|---|---|---|---|---|
| Innovation | 15 | 55 | 40.34 ± 6.37 | 3.66 ± 0.57 |
| Cognitive maturity | 13 | 41 | 27.51 ± 5.04 | 3.05 ± 0.56 |
| Mental engagement | 13 | 65 | 47.84 ± 8.08 | 3.68 ± 062 |
| Total | 69 | 144 | 115.70 ± 13.55 | |
| Nursing perception | 6 | 30 | 19.17 ± 3.89 | 3.19 ± 0.64 |
| Nursing job satisfaction | 4 | 20 | 14.47 ± 3.07 | 3.61 ± 076 |
| Engagement with the nursing profession | 6 | 30 | 22.53 ± 3.75 | 3.75 ± 0.62 |
| Self-sacrifice for the nursing profession | 18 | 46 | 35.18 ± 4.98 | 3.51 ± 0.49 |
| Total | 34 | 132 | 91.37 ± 11.77 | |
The results of Table 1 illustrate that the scores of critical thinking disposition were higher for married participants (
The results revealed a significant and direct correlation between the nurses’ critical thinking disposition and professional commitment (
Correlation between nurses’ critical thinking disposition and professional commitment.
| Variable | Nursing perception | Nursing job satisfaction | Engagement with the nursing profession | Self-sacrifice for the nursing profession | Total of professional commitment |
|---|---|---|---|---|---|
| Innovation | |||||
| Cognitive maturity | |||||
| Mental engagement | |||||
| Total of critical thinking disposition | |||||
The results of multivariate linear regression (enter method) confirm that critical thinking disposition is a significant predictor of professional commitment in nurses (Table 4). Therefore, nurses with higher levels of critical thinking disposition had higher scores in professional commitment than others. The critical thinking disposition explained 45% of changes in professional commitment.
Multivariate regression model.
| Variable criteria & predictor | Standardized beta value | |||
|---|---|---|---|---|
| Critical thinking disposition | 0.73 | 13.04 | 0.001 | 0.45 |
| Marital status | 0.04 | 0.76 | 0.44 | |
| Attending the professional commitment courses | 0.10 | 1.56 | 0.12 | |
| Attending in critical thinking courses | −0.07 | −0.98 | 0.32 | |
The purpose of this study was to evaluate critical thinking disposition, professional commitment, and the relationship between these 2 variables among nurses. Based on the findings, nurses had a moderate level of critical thinking disposition, which is similar to the results of other studies.19–21 This level of critical thinking disposition can be attributed to training deficiencies, organizational factors such as poor management, and lack of applying the nursing process. Barkhordary et al.21 Pakmehr and Karsheki,22 and Du et al.23 reported that critical thinking disposition of the medical students was at a low level. This discrepancy can be attributed to the differences in participants, data collection tools, and study setting. In these studies, the participants were students; as a fact, students are may not be well-engaged in practical work and lack the required skills to solve problems and engage intellectually to address the issues. However, some studies reported high levels of critical thinking among the participants.24
Our findings indicated that the highest level of critical thinking disposition was related to the aspect of mental engagement, while the lowest score was attributed to the cognitive maturity. Some studies were consistent with our research.17,21,25 Implementation of the best and most appropriate nursing techniques requires well-timed and accurate decision-making by emphasizing on the lifelong learning, ways of learning, and creative thinking.26
Our findings represented that the mean score of nurses’ professional commitment was at a high level. Other researchers also reported similar results.13,27,28 Commitment is an internal power that encourages the individuals not to quit their jobs even under difficult conditions. High professional commitment can be caused by interest in occupation as well as sense of humanity and affection. Since nursing is intrinsically a humanfriendly job and sense of responsibility and compassion for patients is one of its fundamental values, high professional commitment is expected in nurses. Another reason for nurses’ high commitment may be their satisfaction with the nursing profession. In this regard, researchers indicated that the community’s understanding and supporting, working as a part of the care team, and being officially recognized had the most impact on the nurses’ job satisfaction.29 However, nursing job satisfaction was not assessed in this study.
Contrary to the present research, in a study of Jordanian nurses, Al-Hamdan et al. (2018) found that the nurses had a moderate level of professionalism and that nurses’ professional commitment had a significant and positive relationship with patient safety.30 Siraneh et al. (2018) among health service providers in Ethiopia, and Zabol et al. (2019) among the Iranian nurses indicated that professional commitment was low. Such discrepancy in the results may be due to the participants’ cultural and social differences, research environmental conditions, and research tools. In our study, the highest mean score of professional commitment was attributed to the aspect of engagement with nursing profession, while the lowest score was attributed to the aspect of nursing perception.30–32 In contrast to our results, Shali et al.13 reported that the lowest mean score was related to job satisfaction and the highest to the self-sacrifice for the nursing profession.13
The results showed a significant and direct relationship between critical thinking disposition and professional commitment. Moreover, the findings confirmed that critical thinking disposition was a significant predictor of professional commitment in nurses. This result can be caused by the fact that nurses consider taking care of patients and rendering health services as a part of their human and occupational duty. They need critical thinking to deliver the best care and improve their job performance to make specific and correct decisions based on specific situations. To our knowledge, no study has explored this topic. However, in parallel with our study, 2 studies on nurses showed that professional commitment had a positive and significant relationship with job satisfaction.14,33 Alkin-Şahin (2015) found teachers’ critical thinking dispositions as an important component of their professionalism.34 Konge et al.27 studied 3 medical schools in different provinces of China and found that the students with poor job satisfaction had a low level of professional commitment. On the contrary, Ebrahimipour et al. (2014) found no significant correlation between critical thinking and job satisfaction in Iran. Based on our results, married nurses who participated in educational courses on commitment training and critical thinking had a high critical thinking disposition.35 In line with the present study, a study in Iran found a significant correlation between critical thinking and marriage among students of rehabilitation fields.36
This high critical thinking disposition among married students can be due to their better life skills that lead to effective decision-making, problem solving, creative thinking, empathy and patience in facing problems, and having communication. In contrast to the present study, Hasanpour et al. (2015) reported no significant difference between marital status and critical thinking disposition in Iranian participants. The reason for these differences can be attributed to the differences in characteristics of research participants, data collection tools, and the number of studied participants.37
In addition, our findings indicated that married people had higher professional commitment, which is supported by Mirzapour Al Hashim et al.38 These findings can be because commitment to life and family is more prevalent among married than single people or because the economic and social needs of married people that force them to maintain a job. However, Shali et al.13 found no significant difference between the scores of professional commitments of nurses and marital status.
Since this study was conducted in only one city with a limited number of participants and a cross-sectional design, generalization of the findings should be considered with caution. Longitudinal studies in other clinical and educational settings would yield more accurate results.
The results showed that the level of professional commitment was high in nurses and their critical thinking disposition was moderate. Moreover, a positive relationship was observed between professional commitment and critical thinking disposition. Therefore, nurturing critical thinking disposition in nurses is of great importance. To this end, nursing managers and educators are recommended to take measures such as changing the educational program by implementing new teaching strategies, building culture, motivating nurses, and promoting self-assessment. The lowest mean score of critical thinking disposition was correlated to cognitive maturity. To strengthen critical thinking disposition in all aspects in nurses, the traditional educational system should be revised into a novel system by holding in-service training classes. In the case that critical thinking grows in students, they can focus on complex issues, immerse deeply into the study subject, and examine the connections carefully, and process them in their own way. To reach the aforementioned goals, creating motivation in nurses is one of the key points. Furthermore, nurses should be trained to face everyday occupational issues to provide optimal care. Future researchers can also examine the facilitating factors and barriers to critical thinking and professional commitment of nurses and nursing students using qualitative and quantitative studies.