The role of critical thinking in a certificate program: the nursing assistant

Critical thinking skills make the difference between life and death for hospitalized patients;
nursing staff must recognize small and subtle changes in a patient’s condition and act quickly. The aging
population of the U.S. and the attrition of nursing staff have increased the need for nurses and nursing
assistants. Community college Certified Nursing Assistant (CNA) programs can be a gateway course for
multiple health careers, especially nursing. These programs are short two- to three-month programs that
culminate in a certificate and employment. The challenge finding ways to add meaningful critical thinking
approaches to the curriculum of short skills-based courses.
This mixed methods study examined the critical thinking skills of nursing assistants and identified
ways to impact students’ ability to make informed decisions. Quantitative questions examined students’
performances on a critical thinking test compared with national results and the effect of critical thinking
lessons prior to the test on those results and the statewide credentialing test. Qualitative questions
examined students’ perceptions of the test and the classroom exercises on their confidence and
understanding of critical thinking. Critical thinking classroom interventions focused on prioritizing care,
identifying potential problems, and making decisions about appropriate care, including when to alert the
nurse to changes in the patients’ condition.
Quantitative results showed a slight improvement in the students’ scores on the critical thinking
test and state credentialing exam; however, these were not statistically significant. Qualitative results
indicated students learned from the lessons and could apply them to their clinical and classroom
experiences. Recommendations from this study include (1) Critical thinking exercises should be
embedded into CNA programs; (2) Faculty must model critical thinking and actively demonstrate critical
thinking decision making; (3) Faculty should mentor students to encourage reflective practice and ensure
student awareness and assessment of their own thinking process; (4) Community colleges should
establish First Year Seminar courses as a means to embed critical thinking components into CNA
programs.