| Objective and background:About2400years ago, Socrates had explained and explored critical thinking, but systematic and scientific research of critical thinking dated in the last century in America. Critical thinking is a positive and rational way of thinking about human, things and objects, which guides people to regulating self-cognition. It is an art of the thinking which can improve one’s thinking. It is not only a manifestation of the comprehensive thinking ability, but also a reflection of human spirit. In the1980s the research of critical thinking was introduced to nursing and received wide attention rapidly. It was considered to be the sign of improvement of nurses’quality. During1995-1998, Scheffer and Rubenfeld used Delphi to combine the views of88nursing experts from nine countries, considered critical thinking as an important quality of nurses to ensure the quality of nursing. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) proposed that critical thinking was one of abilities of health care workers. Its application can go through the entire nursing process, and penetrate all of the nursing practice. Critical thinking is the essential ability in nursing clinical practice, which also can distinguish experts from common nurses. The rapid development of medicine technology and continuous emergence of interdisciplinary subjects, drive clinical medicine to be divided more professionally, and require nursing technology to be more professional, constantly promote the development of nursing professionally. Thus nursing specialists emerge. They make up for the deficiencies of conventional nursing, meet different demands of the people, and reflect the unique value and contribution of nursing in the health care. Broadly, the nursing extends to community and family. Deeply, the function of nursing is becoming more and more professional. To face complex care environment, nurses need to possess questioning and reasoning skills, provide patients with the best care to meet their individual needs, and evaluate its effectiveness, which require nurses to use critical thinking. Critical thinking, as the basement of clinical decision-making and problem-solving, becomes the most important part of professional competence of nursing specialists. The stronger the critical thinking of nurses is, the better the collection, assessment and analysis ability of nurses are. If the critical thinking disposition of nurses is cultivated, it will continue to guide their autonomous activity to ensure the quality of nursing, thus a simple and effective scale is essential. At present, the California Critical Thinking Disposition Inventory (CCTDI), which was published by Facione in1992, is the only one which can effectively measure the critical thinking disposition all over the world, because the scale can be applied to anyone, and explicitly the critical thinking disposition can be known with fewer items. From1992, many scholars revised the scale to make it more appropriate. The CCTDI gets a satisfactory reliability and validity, but it is developed by western scholars based on the western culture, it’s not appropriate to introduce it directly to our country. There are two revised versions of CCTDI in our country, one is the Chinese Version of the California Critical Thinking Disposition Inventory (CCTDI-CV), and the other is the Chinese Version of Critical Thinking Disposition Inventory (CTDI-CV). The CTDI-CV is used widely in the Mainland of China, as the measurement of nursing students or clinical nurses, to explore the relationship of critical thinking disposition and critical thinking skills, learning ability and other skills. However, the sample of the scale were nursing students, whether it can be used widely as CCTDI, we know nothing. It should be tested systematicly if it can be used for nursing specialists. The study aims to assess the reliability and validity of the scale when used for nursing specialists in Guangdong, and revise it, then assess the reliability and validity of the new version.Methods:The study uses cluster sampling to survey these614nursing specialists, who were trained by the department of health of Guangdong Province and the HK Hospital Authority during2007-2010. These registered nurses all conform to the admission requirements of nursing specialists of Guangdong Province, and have accepted professional training of ten months, and gotten the diploma jointly issued by the HK Hospital Authority Institute of Health Care and Institute of Advanced Nursing Studies. Although our country currently has no standard certification system of nursing specialists, nursing specialists included in the study are representative. There are two tools used for the study, one is the general questionnaire, including name, age, marriage, education, gender, job title, post, period of working. Name is used for communication with nursing specialists who agree with re-survey. These names will be deleted in the procedure of statistical analysis. The other is CTDI-CV, published by Professor Peng Meici in2004. We have got Peng’s agreement that the scale can be used as a measurement tool in our study. The scale contained70items with7subscales, these subscales separately are truth-seeking, open-mindedness, analyticity, systematicity, self-confidence, inquisitiveness and maturity, each one has ten items. The format of the CTDI-CV is a6-point, forced-choice Likert scale of agree-disagree response alternatives. The higher the score is, the stronger the critical thinking disposition is. We use Cronbach’s alpha coefficient to examine the internal consistency between different items, intraclass correlation coefficient to examine the test-retest reliability, AMOS7.0to examine construct validity of the scale by confirmatory factor analysis. If the result does not fit, we will use item analysis and factor analysis to obtain more suitable scale to measure the critical thinking disposition of nursing specialists.Results:(1) Cronbach’s a of the overall CTDI-CV which was tested among nursing specialists, is0.911and for the seven subscales, the alpha ranges from0.571to0.719. The test-retest reliability of the overall scale is0.905, and test-retest reliability of the subscale ranges from0.505～0.721.(2) The result of the confirmatory factor analysis is:P=0.000, RMR=0.233, RMSEA=0.070, GFI=0.600, AGFI=0.577; NFI=0.284, RFI=0.264, IFI=0.369, TLI=0.345, CFI=0.363; PGFI=0.567, PNFI=0.276, PCFI=0.353, CN=145, X2/df=3.127, values of AIC and CAIC are not good. The result suggests that the original model does not fit the data well.(3) After the item analysis of70items which includes item distribution, coefficient of variation, CR values, homogeneity testing and factor loadings,48adverse items are removed. The remaining22items are analysed with the method of factor analysis and decrease to18items with three dimensions, which is named the Simple Chinese Version of Critical Thinking Disposition Inventory (CTDI-SCv). The total explained variance is up to48.160%. Cronbach’s alpha for overall and each subscale are over0.80, the test-retest reliability is over0.60. The commonality of all entries is above0.30, and the factor loadings are all over0.45.(4) The Confirmatory Factor Analysis indexes of the new scale are:P=0.000, RMR=0.059, RMSEA=0.048, GFI=0.943, AGFI=0.903; NFI=0.938, RFI=0.905, IFI=0.974, TLI=0.959, CFI=0.973; PGFI=0.557, PNFI=0.619, PCFI=0.642, CN=221,X2/df=1.688, the values of AIC and CAIC are also good. The new scale’s structure is more appropriate than the original scale of CTDI-CV.(5) Researchers have discussed with many experts to determine the definition and the name of these factors and item content. Finally, the content of nine entries of the new scale are modified to make it more suitable for the Mainland language expression and easy understand. The three factors are separately named cognitive thinking, rational thinking and systematic thinking. Cognitive thinking is a dynamic thinking process defined that people can obtain knowledge through human perception, make a judgment, and ultimately solve a problem. Rational thinking is defined that one can fully understand the nature and the internal connections of things on the basis of objective evidence or logical reasoning. One can analyse a variety of solutions calmly, and select the most appropriate solution to solve a problem, make events or people’s actions consistent with the particular purpose. Systematic thinking is that one can grasp the whole of things, organize and handle his different kinds of thoughts properly. It is a special thinking method to systematizing the thinking results.(6)The application of CTDI-SCv proves that nursing specialists in Guangdong have a positive critical thinking disposition, but not strong.Conclusion:The new scale is an efficient measurement tool to measure the critical thinking disposition of nursing specialists with a good reliability and validity, which can provide a good reference for knowing the critical thinking disposition of nursing specialists. |
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