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Critical thinking is useful in analyzing complex data, evaluating situations and actions, and implementing the most appropriate actions; it is a requirement for effective problem solving and decision-making in all walks of life. In view of these characteristics, enhancement of CT is regarded as a valuable outcome for any programme in higher education including nursing (Ku, 2009; Maudsley & Strivens, 2000; Mundy & Denham, 2008; Profetto-McGrath, 2005; Spencer, 2008; Staib, 2003).Thinking is not driven by answers but by questions. If experts, scientists, philosophers had not asked questions, the foundations of fields of thought, for example Physics or Biology, would not have been developed in the first place. Furthermore, every field stays alive only to the extent that fresh questions are generated and taken seriously as the driving force in a process of thinking. To think through or rethink anything, one must ask questions that stimulate thought. Questions define tasks, express problems and delineate issues. Answers on the other hand, often signal a full stop in thought. Only when an answer generates a further question does thought continue its life.
Critical thinking is identified as a fundamental competency expected of baccalaureate nursing students at the completion of their programme. Several authors assert that a key strategy to develop and promote critical thinking is Craig & Page, 1981; Daly, 1998; Phillips & Duke, 2001; Rossignol, 1997; Schell, 1998; Sellappah et al., 1998; Wink, 1993.This paper details the findings from a study undertaken to explore, describe and compare the types and levels of questions asked by tutors (nurse and non nurse educators) and their students during classes that use a context-based learning approach in a baccalaureate nursing programme. The proposed study is designed to determine the effectiveness of a critical thinking course in enhancing critical thinking skills of nurse and non-nurse educators teaching in a BScN programme at nursing schools/colleges.The aim of this study is to understand the types and levels of questions asked by nurse and non nurse educators in a BScN degree programme (Years I to IV) in order to effectively promote student learning.
Effective questioning is one of the most important teaching strategies and it plays a vital role in creating an effective learning environment. Literature suggests that questioning is an active process whereby students can learn effectively. According to Nicholl and Tracey (2007) there are many types of questions ranging from low level closed questions to challenging questions. Low level closed questions require the student to do no more that recite facts and figures or to recall information, while challenging higher order questions require the student go beyond simple recall and to engage in more sophisticated thinking so that deep learning occurs (Ramsden, 2003). High order questions and open ended questions require students to use their knowledge to problem solve, reason, think deeply and critically, analyze, evaluate and develop creative new insights. In addition, such questions engage students in higher order cognitive processes.Developing the ability to think critically is influenced by many factors, including the learning environment and the instructor's competence and approach to teaching (Simpson & Courtney, 2002). Above all, educators must recognize the value of CT and be prepared to promote it. For teachers to prepare students with higher level cognitive thinking "they must first emulate higher level thinking in their instructional practices" (Ball & Garton, 2005, p.58- 69). Facione and Facione (1996) emphasize that CT needs to be demonstrated, and that demands constant metacognitive reflection on "what one is doing and why" (p. 133).
Phillips and Duke (2001) suggest that in the literature there is evidence that many teachers use mainly factual and lower level questioning, as they rely on simple recall questions that results in a narrow range of responses. These questions do not promote critical thinking as they usually result in a yes or no answer; they create no opportunity for further discussion and assess only lower order thinking. Salpellah et al. (1998) in a study of questioning by clinical teachers found that they predominately asked questions from the lower order cognitive levels. Effective questioning involves cognitive reasoning and critical thinking at an appropriate level for the student. In doing this, the teacher plans to draw on and develop the student's lower to higher thinking skills. It is considered useful to use an educational hierarchy to ask questions, which move from simple recall of information to the more difficult skills of cognitive reasoning and critical thinking.
These levels of thinking could be / should be developed into a hierarchy, so that each successive level requires the student to use more complex cognitive processes to arrive at an answer. There are a number of taxonomy classifications developed including that of Bloom's (1956) taxonomy, which is generally useful in designing questions . This widely acknowledged taxonomy has six major components as listed and developed in Table 1.
Table 1. Bloom's Taxonomy
This lowest level entails recalling facts or observations in the exact form that has been presented, or supplying specific factual information, It includes memorization of definitions, formulae or procedures.
This level of ability involves understanding the previously learned material, being able to restate material in the student's own words and comparing and contrasting information, They should also be able to recognize previously unseen example' of a
This level involves the student in applying known rules and techniques to problem
solve without being given the rule or formula to solve the problem.
This level entails the skills of making inferences, finding evidence to support
generalization, skills required to break complex concepts or situations into their
component parts, and analyze how these parts are related to one another.
This-level involves developing solutions to problems, making predictions or
rearranging component parts to form a new whole.
This level is the highest cognitive level I and entails the student making value
judgments about a controversial issue, judging the validity of an argument or the
worth of a concept and arriving at a reasoned judgment.
Source: ???????????????????????????? Bloom, B.S.( 1956
In preparing the questions, the teacher should select questions at an appropriate level in this taxonomy for the learning outcomes and phrase questions that promote the development of higher order thinking.
Research studies advise that many teachers use factual and lower level questions, which do not promote CT (Craig & Page, 1981; Giddins et al., 2000; Nicholl & Tracey, 2007; Profetto-McGrath et al., 2004; Sellappah, Hussey). Lower level questioning, related to recall of information or comprehension, is important while facilitating the teaching and learning process. However, to foster CT, nurse educators are required to develop skills to ask higher level questions that involve analysis, synthesis, and evaluation (Profetto-McGrath et al., 2004).
The limited research in the Pakistani context reveals that didactic teaching and rote learning are still prevalent in most teaching institutions and disciplines. In the study of teachers' education in Pakistan, Davies and Iqbal (1997) reported that the majority of teaching was lecture based, notes were dictated to students. Some students did not take any notes, but just listened to the lectures and then used the text books to prepare for examinations. Similarly, in1998, a nation wide study, involving 17 schools of nursing in the public and private sectors in Pakistan, was conducted to evaluate the implementation of the revised curriculum for a diploma in general nursing. This study clearly indicated that nursing students were not encouraged to think and to ask question. This was reflected in a comment made by a student: "If we say, 'I have not understood', I am told, 'No need to understand, just remember it" (Kamal, 1999). In their study of assessing the critical thinking skills of faculty, Zygmont and Schaeffer (2006) concluded that although it is the primary responsibility of the educators to develop CT of their students, educators find it challenging to do so if they have not trained how inculcate CT in their educational system. This appears to be the same in Pakistan. Moreover, considering the socio-cultural dimension of CT the Pakistani learners may be viewed as members of a culture that does not encourage questioning people who by virtue of their age or position are in authority.
In addition, 5.37 % of the questions were vague while a little over ten percent 13.2% of the questions were rhetorical, affective, motivating or probing in nature. Moreover, field notes of the researchers' observations showed that most teachers were not giving enough wait-time to students after posing their questions. In fact, they tend to answer their own questions, which do not allow the students to think and respond. In addition, some teachers wrote a question on a power point slide and had the answer written below on the same slide, which made the question redundant as there was not wait-time for the students to reflect and respond.
Discussion and Conclusion
The findings of this study indicate that the learning environment in a classroom of undergraduate BScN programmes is not always conducive in promoting critical thinking.
The findings indicate that many educators in the baccalaureate program mostly used lower level questions. It was observed that these types of questions did not require knowledge acquisition; they were merely required for students to repeat or at best recall information. Answers could be predicted as they required limited thought from the students. The questions did not promote critical thinking either as they usually resulted in a "Yes" or a "No" answer. Most of the teachers used the Closed questioning technique which also involves the recall of simple facts, which could be done by rote-memorization - responses that entail a superficial understanding of the topic.
Questions at higher levels of Bloom's taxonomy are usually most appropriate for encouraging students to think more deeply and critically. They enhance students' problem solving capabilities, facilitate discussions and encourage them to seek information on their own.
These findings are similar to findings reported in previous studies (Craig & Page, 1981; Giddins et al., 2000; Phillips& Duke, 2001; Scholdra & Quiring, 1973; Sellappah et al., 1998. Furthermore, unlike the findings of Profetto-McGrath et al. (2004) and Sellappah et al. (1998), the percentage of rhetorical and vague questions may indicate uncertainty or doubt were considerably high in this study. This could perhaps be related to the educators' inadequate command of the English language in addition to their lack of knowledge in terms of using the questioning skills ineffectively.
The results of this study indicate that although the majority of the questions asked by the teachers were of the low level category, these type of questions are considered important to ask to reinforce knowledge acquisition at the basic level. Moreover, such questions typically cater to students' queries. However, educators need to increase the number of questions that require analysis, synthesis, and evaluation, in addition to questions that involve probing, exploration, and explanation to activate and facilitate critical thinking. The results thus highlight the importance of training the teachers in order to promote critical thinking by asking questions of higher levels. Wink (1993 ) suggests, cognitively high-level questions were not asked because students did not have the fundamental knowledge and until this is well-developed students may not have the capacity, inclination and confidence to respond to or construct high-level questions.
One questioning technique, which is essential to the development of higher thought processes, is wait-time. This is the amount of time that elapses between a teacher asking a question and calling upon a student to answer that question. The average teacher's wait-time is one second; however, an increase in teacher wait-time sets an atmosphere more conducive to productive questions on higher thinking levels. Students also used the wait-time to organize more complete answers. The findings in this study seem to correspond with those reported in previous studies (Swift & Gooding, 1996).
It has been reported that a teacher should/could increase his / her wait-time to 5 seconds or longer if needed. An increase in wait time gives ample time to "slow" or shy learners to formulate their answers.
The educators need to increase the number of questions requiring analysis, synthesis, and evaluation as well as questions that involve probing, exploration, and explanation to activate and facilitate critical thinking. To achieve the true goal of higher education, educators must have the knowledge and skills in the development and delivery of the nursing curriculum to promote critical thinking. Within the literature there are many reasons, why teachers do not use this teaching strategy. The literature continues to suggest that many teachers use low level questioning, which requires simple recall of informationat the lowest level of Bloom's taxonomy (Phillips & Duke, 2001).
Recommendations for Nursing Education
The results of the current study reinforce the need to develop questioning skills in order to teach various aspects of questioning to nurse educators and students. These aspects include development and formulation of various levels (from all levels of Bloom's Taxonomy) and types of questions, and techniques related to questioning.
The continuing education workshops should be offered to educators and teachers to make them aware of the importance of classroom questioning and how they can improve their students' critical thinking.
Nurse educators must be trained and exposed to the delivery of questions by offering workshops, short coursesâ€¦â€¦..
Nurse educators must have command on the content delivery but need to incorporate the current knowledge and trends irrespective of the medium of instruction------