Developing critical thinking in nursing education: integrative review

Authors

DOI:

https://doi.org/10.61799/2216-0388.1969

Keywords:

nursing education, educational strategies, higher education, critical thinking

Abstract

Nursing education raises the need for educational transformations to achieve higher levels of critical thinking skills among nurses, which are expressed in decision-making, clinical judgment, leadership, and intervention in healthcare management in today's complex social environments, in addition to the benefits for students' personal, professional, and social lives. Objective: To identify the teaching strategies used to develop critical thinking in undergraduate nursing education. Methodology: A secondary research study was conducted, using an integrative review, which included 38 articles. The search was conducted in the following databases: PubMed, Science Direct, Scopus, and LILACS, applying filters for open access to full text, published between 2020-2025, in English, Spanish, and Portuguese. The search and selection of articles followed the recommendations of the PRISMA 2020 statement, and the thematic analysis followed the methodology proposed by Dhollande et al. Results: Of the 38 articles, eleven were literature reviews, twenty were quantitative studies, and seven were qualitative studies, conducted mainly in Asian countries, followed by Europe and Latin America. Three themes emerged from the thematic analysis: Seeking ways to develop critical thinking in nursing students; Factors involved in teaching critical thinking to nursing students; and Measuring critical thinking: Diagnosis of the state or evaluation of the process. Conclusion: There is evidence of teaching strategies with positive effects on critical thinking skills in nursing students; however, programs need to carry out processes of conceptualization, reflection, and faculty training on critical thinking so that the planning and implementation of strategies are cross-cutting in the curriculum.

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Author Biographies

  • Olga Marina Vega Angarita, Universidad Francisco de Paula Santander, Cúcuta, Colombia.

    Enfermera. Magister en Enfermeria. Doctora en Educación. Profesora  Titular Universidad Francisco De Paula Santander. Investigador Senior Grupo de Investigación Cuidado de la Salud- GINCUS

  • Gloria Esperanza Zambrano Plata, Universidad Francisco de Paula Santander, Cúcuta, Colombia.

    Enfermera. Magister en Enfermería. Doctora en Educación. Profesora Asociada Universidad Francisco de Paula Santander. 

  • Mabel Osnaya Moreno, Universidad Autónoma del Estado de Morelos, Cuernavaca, México.

    Psicóloga. Doctora en Educación. Profesora Investigador Asociado Tiempo Completo. Instituto  de Ciencias de la Educación, Universidad Autónoma del Estado de Morelos. Cuernavaca, México.

  • Héctor Santos Nava, Colegio de Bachilleres del Estado de Morelos, México.

    Licenciado en Educación. Doctor en Educación.  Post Doctorado en Educación ( en curso), Instituto de Ciencias de la Educación. Universidad Autónoma del Estado de Morelos, Cuernavaca, México.

References

[1] M. Vendrell-Morancho, "Desarrollo del Pensamiento Crítico en la Universidad: Estrategias para superar desafíos y fomentar su crecimiento," Revista de la educación superior, vol. 53, no. 210, pp. 1-22, 2024. https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-27602024000200001

[2] M. Vendrell-Morancho and A. V. Moya, "Cartografía del pensamiento crítico: principales aportaciones para repensar la educación," Educação e Pesquisa, vol. 51, e278119, 2025, https://doi.org/10.1590/S1678-4634202551278119es

[3] OECD, OECD Skills Outlook 2021: Learning for Life. Paris: OECD Publishing, 2021. https://doi.org/10.1787/0ae365b4-en

[4] J. F. Oliveira, E. Z. Perez, M. B. G. Ferreira, P. D. S. Pires, E. Barichello, and M. H. Barbosa, "Cultural adaptation and validation of an instrument about nursing critical thinking skills," Revista Brasileira de Enfermagem, vol. 74, no. 2, e20200720, 2021, https://doi.org/10.1590/0034-7167-2020-0720

[5] S. Willers, T. Jowsey, and Y. Chen, "How do nurses promote critical thinking in acute care? A scoping literature review," Nurse Education in Practice, vol. 53, 103074, 2021, https://doi.org/10.1016/j.nepr.2021.103074

[6] Organización Mundial de la Salud, Situación de la enfermería en el mundo 2020: invertir en educación, empleo y liderazgo [State of the world's nursing 2020: investing in education, jobs and leadership]. Ginebra: Organización Mundial de la Salud, 2020. Disponible: https://www.icn.ch/sites/default/files/2023-04/SOWN_Report_SP.pdf

[7] C. Baker, A. H. Cary, and M. da Conceicao Bento, "Global standards for professional nursing education: The time is now," Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing, vol. 37, no. 1, pp. 86–92, 2021, https://doi.org/10.1016/j.profnurs.2020.10.001

[8] M. A. Jiménez-Gómez, L. Cárdenas-Becerril, M. B. Velásquez-Oyola, M. Carrillo-Pineda, and L. Y. Barón-Díaz, "Reflective and critical thinking in nursing curriculum," Revista Latino-Americana de Enfermagem, vol. 27, e3173, 2019, https://doi.org/10.1590/1518-8345.2861.3173

[9] L. Cárdenas-Becerril, M. A. Jiménez-Gómez, M. D. Bardallo-Porras, J. López-Ortega, A. Monroy-Rojas, and V. A. A. Püschel, "Presence of the reflective and critical thinking capacity in nursing curricula in Iberian America," Investigación y Educación en Enfermería, vol. 38, no. 3, e14, 2020, https://doi.org/10.17533/udea.iee.v38n3e14

[10] M. Vendrell-Morancho and J. M. Rodríguez-Mantilla, "Pensamiento crítico: conceptualización y relevancia en el seno de la educación superior," Revista de la Educación Superior, vol. 49, no. 194, pp. 9–25, 2020, https://doi.org/10.36857/resu.2020.194.1121

[11] C. E. Toronto and R. Remington, A Step-by-Step Guide to Conducting an Integrative Review. Cham, Switzerland: Springer Nature, 2020. https://doi.org/10.1007/978-3-030-37504-1

[12] M. J. Page, J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, L. Shamseer, J. M. Tetzlaff, E. A. Akl, S. E. Brennan, R. Chou, J. Glanville, J. M. Grimshaw, A. Hróbjartsson, M. M. Lalu, T. Li, E. W. Loder, E. Mayo-Wilson, S. McDonald, L. A. McGuinness, and D. Moher, "The PRISMA 2020 statement: an updated guideline for reporting systematic reviews," BMJ, vol. 372, n71, 2021, https://doi.org/10.1136/bmj.n71

[13] E. von Elm, D. G. Altman, M. Egger, S. J. Pocock, P. C. Gøtzsche, and J. P. Vandenbroucke, "Declaración de la iniciativa STROBE (Strengthening the Reporting of Observational Studies in Epidemiology): directrices para la comunicación de estudios observacionales," Revista Española de Salud Pública, vol. 82, no. 3, pp. 251–259, 2008. Disponible: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-57272008000300002

[14] S. Dhollande, A. Taylor, S. Meyer, and M. Scott, "Conducting integrative reviews: a guide for novice nursing researchers," Journal of Research in Nursing, vol. 26, no. 5, pp. 427–438, 2021, https://doi.org/10.1177/1744987121997907

[15] F. Díaz-Barriga, Enseñanza situada: vínculo entre la escuela y la vida. México: McGraw-Hill, 2006.

[16] R. I. Vega-Flores, M. H. Díaz-Araya, J. R. Sánchez-Rodríguez, and L. A. Muñoz-González, "Características del proceso enseñanza aprendizaje vinculado al pensamiento crítico desde la mirada de docentes y estudiantes de enfermería," Rev. cuba. enferm, vol. 37, no. 1, 2021. Disponible: https://revenfermeria.sld.cu/index.php/enf/article/view/3654

[17] B. Wei, H. Wang, F. Li, Y. Long, Q. Zhang, H. Liu, X. Tang, and M. Rao, "Effectiveness of problem-based learning on development of nursing students' critical thinking skills: A systematic review and meta-analysis," Nurse Educator, vol. 49, no. 3, pp. E115–E119, 2024, https://doi.org/10.1097/NNE.0000000000001548

[18] H. K. Son, "Effects of S-PBL in maternity nursing clinical practicum on learning attitude, metacognition, and critical thinking in nursing students: A quasi-experimental design," Int. J. Environ. Res. Public Health, vol. 17, no. 21, 7866, 2020, https://doi.org/10.3390/ijerph17217866

[19] W.-L. Ge, X.-Y. Zhu, J.-B. Lin, J.-J. Jiang, T. Li, Y.-F. Lu, Y.-F. Mi, and T.-H. Tung, "Critical thinking and clinical skills by problem-based learning educational methods: An umbrella systematic review," BMC Med. Educ., vol. 25, no. 1, 455, 2025, https://doi.org/10.1186/s12909-025-06951-z

[20] S. Ahmady and S. Shahbazi, "Impact of social problem-solving training on critical thinking and decision making of nursing students," BMC Nursing, vol. 19, 94, 2020, https://doi.org/10.1186/s12912-020-00487-x

[21] J. F. Villalta-Rosillo, J. I. Contreras-Briceño, H. Elizalde-Ordóñez, and M. I. Ordóñez-Sigcho, "Desarrollo del pensamiento crítico del estudiante de enfermería en la práctica preprofesional," prosciences, vol. 6, no. 44, pp. 116–124, 2022, https://doi.org/10.29018/issn.2588-1000vol6iss44.2022pp116-124

[22] J. S. León, K. Winskell, D. A. McFarland, and C. del Rio, "A case-based, problem-based learning approach to prepare master of public health candidates for the complexities of global health," American Journal of Public Health (ajph), vol. 105, suppl. 1, pp. S92–S96, 2015, https://doi.org/10.2105/AJPH.2014.302416

[23] C. Ma and W. Zhou, "Effects of unfolding case-based learning on academic achievement, critical thinking, and self-confidence in undergraduate nursing students learning health assessment skills," Nurse Education in Practice, vol. 60, 103321, 2022, https://doi.org/10.1016/j.nepr.2022.103321

[24] Y. Xiang, D. Liu, L. Liu, I.-C. Liu, L. Wu, and H. Fan, "Impact of case-based learning on critical thinking dispositions in Chinese nursing education: A systematic review and meta-analysis," Front. Med, vol. 12, Mar. 2025, https://doi.org/10.3389/fmed.2025.1452051

[25] E. Garza-Hernández, M. C. Meléndez-Méndez, J. F. González-Salinas, M. D. S. Rangel-Torres, H. Castañeda-Hidalgo, and E. Sánchez-Castellanos, "Percepción hacia la simulación clínica como experiencia de aprendizaje en estudiantes de licenciatura de enfermería," Investig. Enferm. Imagen Desarr, vol. 25, 2023, https://doi.org/10.11144/Javeriana.ie25.psce

[26] J. O'Flaherty and M. Costabile, "Using a science simulation-based learning tool to develop students' active learning, self-confidence and critical thinking in academic writing," Nurse Educ. Pract, vol. 47, 102839, 2020, https://doi.org/10.1016/j.nepr.2020.102839

[27] F. Saghafi, N. Blakey, S. Guinea, and T. Levett-Jones, "Effectiveness of simulation in nursing students' critical thinking scores: A pre-/post-test study," Clinical Simulation in Nursing, vol. 89, 101500, 2024, https://doi.org/10.1016/j.ecns.2023.101500

[28] Y. Wang, Y. Peng, and Y. Huang, "The effect of 'typical case discussion and scenario simulation' on the critical thinking of midwifery students: Evidence from China," BMC Med. Educ, vol. 24, no. 1, 340, 2024, https://doi.org/10.1186/s12909-024-05127-5

[29] C. G. Rufino, L. de O. Viana, H. F. de Menezes, E. J. de O. Dutra, G. S. C. Valente, and R. A. R. da Silva, "Pensamiento crítico y las estrategias de enseñanza para profesores del curso de graduación en enfermería," Revista Enfermagem UERJ, vol. 28, e41988, 2020, https://doi.org/10.12957/reuerj.2020.41988

[30] S. H. V. Wong and Y. Kowitlawakul, "Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study," Nurse Educ. Today, vol. 95, 104600, 2020, https://doi.org/10.1016/j.nedt.2020.104600

[31] V. García-Franco, R. D. García-Núñez, M. Lorenzo-González, and M. Hernández-Cabezas, "Los mapas conceptuales como instrumentos útiles en el proceso enseñanza-aprendizaje," MediSur, vol. 18, no. 6, pp. 1154–1162, 2020. [Online]. Disponible: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1727-897X2020000601154&lng=es&tlng=es

[32] E. Dirgar, S. Berşe, N. A. Bor, and B. Tosun, "The effect of concept mapping in nursing education on critical thinking motivation: A path analysis," Nurse Educ. Today, vol. 143, 106386, 2024, https://doi.org/10.1016/j.nedt.2024.106386A.

[33] D. P. Carvalho, A. F. Vitor, A. L. P. Cogo, G. K. G. D. Bittencourt, V. E. P. Santos, and M. A. Ferreira Jr., "Critical thinking in nursing students from two Brazilian regions," Revista Brasileira de Enfermagem, vol. 73, no. 1, e20170742, 2020, https://doi.org/10.1590/0034-7167-2017-0742

[34] Barta, L. A. Fodor, B. Tamas, and I. Szamoskozi, "The development of students' critical thinking abilities and dispositions through the concept mapping learning method – A meta-analysis," Educ. Res. Rev., vol. 37, 100481, 2022, https://doi.org/10.1016/j.edurev.2022.100481

[35] H. M. Pratiwi, D. Nani, S. Saryono, and L. M. Cakrawati, "The effectiveness of case-based concept map to improve pathophysiology knowledge and critical thinking among first-year nursing students: a quasi-experimental study," Jurnal Ners, vol. 19, no. 1, pp. 78–87, 2024, https://doi.org/10.20473/jn.v19i1.48114

[36] T. A. Sezer and F. I. Esenay, "Impact of flipped classroom approach on undergraduate nursing students' critical thinking skills," Journal of Professional Nursing, vol. 42, pp. 201–208, 2022, https://doi.org/10.1016/j.profnurs.2022.07.002

[37] T. J. Tseng, S. E. Guo, H. W. Hsieh, and K. W. Lo, "The effect of a multidimensional teaching strategy on the self-efficacy and critical thinking dispositions of nursing students: A quasi-experimental study," Nurse Educ. Today, vol. 119, 105531, 2022, https://doi.org/10.1016/j.nedt.2022.105531

[38] E. Andina-Díaz, "Using Photovoice to stimulate critical thinking: An exploratory study with nursing students," Revista Latino-Americana de Enfermagem, vol. 28, e3314, 2020, https://doi.org/10.1590/1518-8345.3625.3314

[39] L. Veliz-Rojas, P. Argandoña-Gálvez, and R. Vega-Flores, "Percepción sobre un diario reflexivo para el desarrollo del pensamiento crítico en estudiantes de enfermería," Educ. Méd. Super., vol. 35, no. 2, 2021. [Online]. Disponible: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-214120210

[40] T. Stretton, T. Cochrane, C. Sevigny, and J. Rathner, "Exploring mobile mixed reality for critical thinking in nursing and healthcare education: A systematic review," Nurse Educ. Today, vol. 133, 106072, 2024, https://doi.org/10.1016/j.nedt.2023.106072

[41] N. G. AlOtaibi, A. Alshowkan, N. Kamel, A. M. El-Ashry, N. S. AlSaleh, and E. S. Abd Elhay, "Assessing perceptions about critical thinking, motivation learning strategies in online psychiatric and mental health nursing education among Egyptian and Saudi undergraduate nursing students," BMC Nurs, vol. 22, no. 1, 112, 2023, https://doi.org/10.1186/s12912-023-01264-2

[42] J. Zlamal, E. Roth Gjevjon, M. Fossum, M. Trygg Solberg, S. A. Steindal, C. Strandell-Laine, M. Hamilton Larsen, and A. A. G. Nes, "Technology-supported guidance models stimulating the development of critical thinking in clinical practice: Mixed methods systematic review," JMIR Nursing, vol. 5, no. 1, e37380, 2022, https://doi.org/10.2196/37380

[43] National Academies of Sciences, Engineering, and Medicine, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC, USA: The National Academies Press, 2021. doi: 10.17226/25982

[44] D. L. Jaramillo-Gómez, A. J. Álvarez-Maestre, A. E. Parada-Trujillo, C. A. Pérez-Fuentes, D. H. Bedoya-Ortiz, and R. K. Sanabria-Alarcón, "Factores determinantes para el desarrollo del pensamiento crítico en la educación superior," J. Intell., vol. 13, no. 6, p. 59, 2025, https://doi.org/10.3390/jintelligence

[45] T. V. Nguyen, M. F. Tang, S. Y. Kuo, S. H. Hu, T. D. T. Ngoc, and Y. H. Chuang, "Nursing students' critical thinking and associated factors in Vietnam: A multicenter cross-sectional study," Nurse Educ. Pract., vol. 73, 103823, 2023, https://doi.org/10.1016/j.nepr.2023.103823

[46] L. Basco-Prado, A. Biurrun-Garrido, E. Zuriguel-Pérez, J. Roldán-Merino, and O. Mestres-Soler, "Critical thinking level in nursing degree students according to sociodemographic and academic variables: A correlational study," Nurse Educ. Pract., vol. 78, 103955, 2024, https://doi.org/10.1016/j.nepr.2024.103955

[47] D. Zarzycka and M. Gesek, "The factors affecting the critical thinking skills among nursing students – an integrative literature review," Pielegniarstwo XXI wieku / Nursing in the 21st Century, vol. 21, no. 3, pp. 174–180, 2022, https://doi.org/10.2478/pielxxiw-2022-0021

[48] C. M. Boso, A. S. van der Merwe, and J. Gross, "Students’ and educators’ experiences with instructional activities towards critical thinking skills acquisition in a nursing school," International Journal of Africa Nursing Sciences, vol. 14, 100293, 2021, https://doi.org/10.1016/j.ijans.2021.100293

[49] M. A. Cabañas-Rosales, E. Peña-Marcial, L. Reyna-Ávila, F. Godínez-Jaimes, and J. Y. Telumbre-Terrero, "Pensamiento reflexivo y crítico en estudiantes de enfermería: un análisis cualitativo," Ciencia Latina Revista Científica Multidisciplinar, vol. 7, no. 2, pp. 2838–2851, 2023, https://doi.org/10.37811/cl_rcm.v7i2.5525

[50] S. Fernández-Rivas, "Los retos de la evaluación del pensamiento crítico en la educación superior," Poiésis - Revista do Programa de Pós-Graduação em Educação, vol. 14, no. 26, p. 256, 2020, https://doi.org/10.19177/prppge.v14e262020256-274

[51] P. Facione, "Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction". Millbrae, CA: The California Academic Press, 1990.

[52] P. Facione and N. Facione, "The California Critical Thinking Dispositions Inventory (CCTDI); and the CCTDI Test manual". Millbrae, CA: The California Academic Press, 1992.

[53] J. Valenzuela, A. M. Nieto, and C. Saiz, "Critical Thinking Motivational Scale (CTMS): una aportación para el estudio de la relación entre el pensamiento crítico y la motivación," Electron. J. Res. Educ. Psychol., vol. 9, no. 2, pp. 823–848, 2011.

[54] N. Semerci, "Escala de desarrollo de la disposición al pensamiento crítico (CTDH): Estudio sobre la revisión de la validez y la fiabilidad," Revista de Estudios Turcos, 2016, https://doi.org/10.7827/TurkishStudies.9573

[55] A. A. G. Nes, F. Riegel, J. G. Martini, J. Zlamal, P. Bresolin, A. G. D. C. Mohallem, and S. A. Steindal, "Brazilian undergraduate nursing students' critical thinking need to be increased: a cross-sectional study," Revista Brasileira de Enfermagem, vol. 76, no. 1, e20220315, 2022, https://doi.org/10.1590/0034-7167-2022-0315

[56] Y. Zhao, Y. Liu, and H. Wu, "Relationships among critical thinking disposition components of Chinese undergraduates: A moderated mediating effect analysis," Int. J. Educ. Res., vol. 124, 102306, 2024, https://doi.org/10.1016/j.ijer.2023.102306

[57] M. Dong, F. Li, y H. Chang, "Trends and hotspots in critical thinking research over the past two decades: Insights from a bibliometric analysis", Heliyon, vol. 9, no. 6, art. no. e16934, jun. 2023, https://doi.org/10.1016/j.heliyon.2023.e16934

[58] E. M. I. Silitonga, R. T. S. Hariyati, H. Handiyani, y A. A. Wildani, «Fostering critical thinking competence in nurses: A systematic review», Nurse Educ. Pract., vol. 92, p. 104730, 2026, https://doi.org/10.1016/j.nepr.2026.104730.

Published

2026-05-01

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[1]
Gonzalez Escobar, D.S. et al. 2026. Developing critical thinking in nursing education: integrative review. Mundo FESC Journal. 16, 35 (May 2026). DOI:https://doi.org/10.61799/2216-0388.1969.

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