Background: Critical thinking (CT) is an essential cognitive skill for nurses,
particularly in high-stakes environments such as surgical wards. Although
previous studies have examined the relationship between CT and clinical
outcomes, few have investigated how CT develops across different nursing
experience levels, especially within the Indian healthcare context.
Aim: To assess and explain the progression of critical thinking skills and
dispositions among nurses at different stages of clinical experience in
surgical units.
Methods: A sequential explanatory mixed-methods design was used. In the
quantitative phase, 40 nurses were stratified by experience level (novice,
competent, expert) and assessed using adapted versions of the California
Critical Thinking Skills Test (CCTST) and Disposition Inventory (CCTDI). Data
were analyzed using descriptive statistics, ANOVA, and post hoc tests. In the
qualitative phase, 20 nurses were selected for in-depth semi-structured
interviews, analyzed thematically. A joint display matrix was used for data
integration.
Results: ANOVA revealed significant differences in CCTST (F (2,37) =
5.94, p = 0.005) and CCTDI (F (2,37) = 4.77, p = 0.012)
scores across experience levels. Experts outperformed novices with
medium-to-large effect sizes. Thematic analysis yielded three key themes: (1)
evolution of decision-making autonomy, (2) depth of reflective practice, and
(3) mentorship as a developmental catalyst. Integrated analysis confirmed
convergence between score trends and narrative insights.
Conclusion: Critical thinking among nurses matures with experience, reflecting both cognitive growth and attitudinal development. Mentorship and structured reflection appear critical to this progression. Findings support experience-sensitive CT training and inform workforce development strategies in surgical care environments.
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