We performed a pretest-posttest quasi-experimental study to examine the effects of GRPQ on CTD of the nursing students, in the school of nursing and midwifery affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. According to the study performed by Vanaki and Tagi on nursing students, calculated sample size included 25 nursing students for each group (
16). However, for increasing the accuracy of the study, all of the 60 students were invited to participate. The students in autumn and spring semesters who had passed the course of nursing care of patients with cardiologic diseases in the previous semester were selected. The students in autumn semester (n = 28) and spring semester (n = 32) were considered as the control and experimental groups, respectively. Six students did not fill in the post-test from the experimental group and were excluded from the study.
Critical Thinking Disposition Inventory (CCTDI) was used for data collection. This questionnaire includes 75 questions, scored from 1 to 6 using a Likert scale from “completely disagree” to “completely agree”, respectively. The questions are organized in seven subscales with 9 - 12 items in each subscale: analyticity (12 questions), critical thinking self-confidence (9 questions), inquisitiveness (10 questions), maturity (10 questions), open-mindedness (12 questions), systematicity (11 questions), and truth-seeking (12 questions). Analysis of the CCTDI consists of scores on each of the seven subscales and on the total overall disposition toward critical thinking. To calculate subscale scores, raw scores are multiplied by 10 and divided by the number of items in the subscale. Obtaining over 50 points in each subscale indicates "strong disposition", while 40 - 50 points indicates "positive disposition" (i.e. high subscale scores), 30-39 points and below 30 points indicates "ambivalent disposition" and "strong opposition" toward critical thinking (i.e. low subscale scores), respectively. Total scores range between 70 and 420. In this regard, obtaining more than 350 points demonstrates "strong and stable disposition", while obtaining 281 - 350 points, 211 - 280 points and 70 - 210 points indicates positive inclination”, “ambivalent disposition" and "strong opposition" toward critical thinking, respectively (
A previously approved, validated and reliable Farsi version of CCTDI was obtained from CCTDI test designers. Prior to the administration of CCTDI in this study, English versions were submitted to a panel of academics (n = 10) in the disciplines of nursing. One of the panel members was a linguistics expert. They were invited to independently judge the items. To assess how closely the Farsi translation resembled the English CCTDI and to determine the content validity as well as whether the items indeed measured the dispositional aspect of critical thinking, panel members suggested to enhance its clarity and readability. After piloting the guide study on 20 eligible nursing students, the re-reliability of the questionnaire was confirmed using Cronbach’s alpha (r = 0.75).
At the beginning, the aim of study was explained for all the students. Then, the clinical education of students began with GRPQ and routine methods. All of students were assigned in 6 to 7 groups, with 5 - 7 students in each group. The clinical education of each group was comprised of six days (three days in two subsequent weeks). At the beginning of clinical education, CTDs pre-test was obtained from all students. After the clinical education period, the post-test of CTDs was obtained from all students. The instructor and the environmental conditions of clinical education course were identical for both groups. Data obtained from the study were reviewed and analyzed by descriptive and inferential statistical methods using SPSS software version 17.0 (frequency counts, percentage, means and standard deviations, Chi-square, independent t-test, paired t-test).
3.1. Guided Reciprocal Peer Questioning (GRPQ) Approach
In this approach, each student will be asked to answer two questions, using root of questions that covers the lesson plan content at the end of teaching program every day, under the guidance of researcher. Then, the students will be asked to present the answers to the others. The students are responsible for finding the correct answers for questions of each other. Partners in two guided questioning conditions are trained to generate thought-provoking questions. Thus, the students will practice the strategy of questioning and responding to the debate and discussion about clinical subjects such as nursing care of cardiac patients during the discussion. The discussion would have continued with questions and answers until the researcher stopped the process. In guided questioning, it would be important that the student cannot turn to the next question before full discussion on the topic is provided. The roots of the questions included: What are the strengths and weaknesses of …?, what is the diference between …?, explain why/how …?, what would happen if …?, what is the nature of …?, why is happening…?, what is a new example of …?, how could be used to …?, what are the implications of …?, what is analogous to …? (
18). 3.2. Routine Clinical Education Approach
For the control group, a traditional teacher-centered method with the purpose of knowledge transfer was used. In this method, students would only learn the practical care of cardiac patients, and they do not focus on questioning about the lessons or what was asked from the coach.