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. 2023 Apr 13;10(8):5129–5138. doi: 10.1002/nop2.1748

Curriculum framework to facilitate critical thinking skills of undergraduate nursing students: A cooperative inquiry approach

Christian Makafui Boso 1,2,✉, Anita S van der Merwe 1, Janet Gross 3
PMCID: PMC10333820  PMID: 37052202

Abstract

Aim

Critical thinking (CT) is vital in assisting nurses to function efficiently in the ever‐changing health care environment. A CT‐based curriculum framework provides the impetus necessary to drive the acquisition of CT skills of students. Yet, there is no known CT‐based framework contextualized to developing countries where seniority tradition is a norm. Therefore, the aim of this study was to develop a CT‐based curriculum framework to facilitate the development of CT skills of nursing students in developing countries.

Design

Cooperative inquiry.

Methods

Using purposive sampling, 11 participants comprising students, educators and preceptors developed a CT‐based curriculum framework.

Results

Findings were organized into a framework illustrating interconnected concepts required to foster CT skills of nursing students. These concepts include authentic student–facilitator partnership, a facilitator that makes a difference; a learner that is free to question and encouraged to reflect; a conducive and participatory learning environment; curriculum renewal processes and contextual realities.

Keywords: cooperative inquiry, critical thinking, curriculum, framework, nursing students, seniority tradition

1. INTRODUCTION

Nurses in today's volatile and complex health care environment need to be able to critically appraise information when giving care (Dozier et al., 2021; Whiteman et al., 2021). Nursing regulatory bodies worldwide such as the Nursing and Midwifery Council of Ghana (2015) and the South African Nursing Council (2014) recognize critical thinking (CT) as crucial for nurses. These bodies require that nursing curricula promote CT skills of students (Dozier et al., 2021; Gholami et al., 2016). The rationale is that individuals with CT skills are potentially able to make good clinical judgements (Dozier et al., 2021; Gholami et al., 2016) which may lead to good patient outcomes (Ward‐Smith, 2020).

Critical thinking‐based curricula adopt learning outcomes, instructional methods and assessment approaches that are grounded on the principles of CT. Such CT‐based curricula create a participatory and democratic learning environment for students. Students will be empowered if they are allowed to take risks, encouraged to make inputs, permitted to share their opinions and if their mistakes are rectified with dignity (Raymond et al., 2017). Thus, as consistent with Billings & Halstead (2005) view, a curriculum should aim at enhancing active learning and the student–faculty interaction (as cited in Billings & Halstead, 2005). Learning environments where divergent views are suppressed (Raymond et al., 2017), and the educator is seen as the authority of information (Boso & Gross, 2015) do not promote CT in students.

A considerable number of reforms in higher education have stressed the need to facilitate CT skills of students (Butler, 2012). CT courses have been introduced in different academic disciplines such as nursing, law, sociology, psychology and philosophy. Despite the attention CT has received, there remains doubt whether graduates are being prepared to think critically (Butler, 2012). At the heart of this challenge is the fact that the concept of CT has not been incorporated into the teaching methods of many educators (Billings & Halstead, 2005). For example, educators construct questions that are mostly at the lower level of thinking (Amoako‐Sakyi & Amonoo‐Kuofi, 2015). This suggests that educational institutions may be failing in their quest to develop CT skills of students (Dunne, 2015).

In many developing countries, nursing schools encounter challenges that may further compound the challenge of assisting students to engage in CT skills. For example, in Ghana, challenges such as limited resources in nursing schools (Talley, 2006) have been reported. Specifically, a lack of qualified educators (Bell et al., 2013), infrastructural and logistical constraints (Talley, 2006), inappropriate instructional methods and large class sizes (Wilmot et al., 2013) are some of the challenges affecting nursing education. Also, as indicated in the authors' previous articles (Boso et al., 2020, 2021c), sociocultural norms uphold the seniority tradition. Traditionally, seniority is valued in most global societies. The aged are viewed as the source of knowledge, power and authority, thus seniority is a dominant cultural norm (Chen & Chung, 2002). For example, an individual is not expected to disagree or question an authority figure in public even if the authority figure appears to be wrong (Donkor & Andrews, 2011). The seniority tradition has been noted as a challenge to facilitating the CT skills of students (Chan, 2013; Raymond et al., 2017). Meanwhile, the complexity of fostering CT skills of students has often been underestimated leading to diverse conceptualizations of CT (Dwyer et al., 2014). Diverse conceptualizations could impede the development of CT skills of students.

Notwithstanding these challenges, a CT‐based curriculum framework could provide the needed impetus to foster the development of CT skills of students. A curriculum framework could provide ‘a means of conceptualizing and organizing the knowledge, skills, values, and beliefs critical to the delivery of a coherent curriculum that facilitates the achievement of the desired curriculum outcomes’ (Billings & Halstead, 2005, p. 167). More importantly, a CT‐based framework provides a participatory and effective learning environment for both the learner and the educator (Dozier et al., 2021; Duron et al., 2006) even in societies where the seniority tradition is strongly adhered to. Yet, these authors could not identify a known curriculum framework to drive the facilitation of CT skills in the context of developing countries where the seniority tradition is a norm.

2. AIM OF THE STUDY

The aim of this study was to develop a CT‐based curriculum framework to facilitate the development of CT skills of nursing students in developing countries.

3. BACKGROUND

This study was underpinned by an eclectic model derived from Dwyer et al.'s (2014) and Duron et al.'s (2006) frameworks of CT development (see Figure 1). This eclectic model addressed four interconnected concepts relating to the exploration of experiences of students and educators towards CT skills facilitation namely CT, memory, comprehension (Dwyer et al., 2014) and instructional activities (Duron et al., 2006). These concepts are further explicated.

FIGURE 1.

FIGURE 1

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Eclectic model of critical thinking development adopted from Duron et al.'s (2006) and Dwyer et al.'s (2014) models of CT. Permission to adapt was obtained.

3.1. Critical thinking

There is no agreement about the definition of CT (Raymond et al., 2018) and its relationship with memory and comprehension (Dwyer et al., 2014). According to Davies and Barnett (2015), there are three main approaches to CT, namely, ‘skills‐and‐judgement’, ‘skills‐plus‐propensity’ and ‘skills‐plus‐disposition‐actions’ perspectives. The skills‐and‐judgement perspective of CT views CT as the possession of a set of characteristic skills. The skills‐plus‐propensity perspective highlights both skills and dispositions aspects of CT. While the ‘skills‐plus‐disposition‐actions’ view, also known as criticality, sees CT beyond skills and disposition to include actions/activism. The skills‐plus‐propensity view on which this study is based recognizes that activism is an outcome of CT and not necessarily an aspect of CT. Thus, Facione's (1990) definition accepted for the purposes of this study illustrates skills‐plus‐propensity perspective of CT: ‘…purposeful, self‐regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon which that judgment is based…’ (Facione, 1990, p. 5).

Though Facione's definition has been criticized for being long‐winded and difficult to implement (Davies & Barnett, 2015), its use for CT assessment in nursing education is evident (Raymond et al., 2017). Dwyer et al.'s (2014) model incorporate both reflective judgement (skills) and self‐regulatory functions of metacognition (disposition) as requirements for CT consistent with Facione's (1990) definition. Self‐regulation refers to the individual's ability, willingness and perceived need to think critically when solving problems.

3.2. Memory

Critical thinking skills are dependent on what information one can remember (Dwyer et al., 2014). Information is either stored in short‐ or long‐term memory. Dwyer et al. (2014) assert that through deliberate attention or perception processes, information is stored as short‐term memory (working memory). This short‐term memory includes two sub‐systems—phonological loop and visuospatial sketchpad; a central executive (attention focussing process that relates to long‐term memory) and episodic buffer (storage centre that integrates new information from working memory with existing memory from long‐term memory) (Baddeley, 2010). Through manipulation, information in short‐term memory may be encoded as long‐term memory. Long‐term memory is stored as schemas (categorization of knowledge based on how it will be used).

3.3. Comprehension

Meaningfully organizing information into schemas for future retrieval requires understanding or comprehension (Dwyer et al., 2014). Comprehension encompasses the ability to translate or interpret information based on previous learning (Huitt, 2011). Long‐term memory and comprehension are fundamental processes for CT application (Dwyer et al., 2014).

3.4. Instructional activities

Duron et al. (2006) designed a 5‐step model to provide a practical impetus in the acquisition of CT skills. This model focuses on steps that educators should take to foster the CT skills of students. The 5‐step framework requires that educators first determine learning objectives. The educator should identify the behaviours that the students should exhibit by the time they exit a course. The objectives should correspond to the higher order of Bloom's taxonomy. Secondly, the importance of teaching through questioning is underlined. The educator should design appropriate questions and questioning techniques to encourage discussion. The questions should vary and be concise to generate student participation. Particularly, divergent questions encourage CT. Thirdly, practice before assessing is considered important – inclusive of learning experiences that encourage active and experiential learning. Fourthly, the educator should continuously review, refine and improve instructional activities for CT skills. These include strategies such as evaluating students' participation through teaching, diary and journaling. Lastly, educators need to provide feedback and assessment of learning. Thoughtful, purposeful and timely feedback should be provided to students on their performance.

It is the contention of these authors that a CT‐based curriculum framework should address factors that either impede or enhance the students' abilities to memorize information (attention/perception processing), comprehend, reflectively make judgement (ability to analyse, evaluate and create) and engage in self‐regulation functions (disposition towards CT). Pursuant to this view, these authors observed classroom instructional practices (Boso et al., 2020), explored the experiences of students and educators (Boso et al., 2021c) and assessed the CT disposition of students (Boso et al., 2021b). These studies revealed a number of issues that informed the development of a CT‐based curriculum framework. For example, challenges such as seniority tradition, large class size; negative attitude, lack of commitment and inappropriate assessment styles/methods of educators; background and culture, learning practices, lack of comprehension of the participant, distractive behaviour of students (Boso et al., 2020, 2021c) were identified. Though students had a confident disposition towards reasoning, they did not have a mindset of truth‐seeking (Boso et al., 2021b). Lack of involvement of students in curriculum reviews and continuous professional development programs on CT for faculty were also identified as challenges in developing CT skills of students (Boso et al., 2021c). Also, educators' examination questions about a higher order of thinking constituted <6% (Boso et al., 2021a).

4. METHODS

4.1. Research design

This article is the concluding part of a larger project (see Boso et al., 2020, 2021a, 2021b, 2021c) that sought to develop a CT‐based curriculum framework. The study used participatory action research (PAR), specifically, cooperative inquiry (CI) as an overarching research design to develop a CT‐based curriculum framework. CI is one of the approaches embedded in PAR (Mash, 2014; Mash & Meulenberg‐Buskens, 2001) and is used interchangeable with PAR in this article. PAR inter alia assists in problem solving (Hart & Bond, 1995; Mash, 2014), promotes organizational improvement (Hart & Bond, 1995), bridges the theory–practice gap (Mash, 2014; Rolfe, 1996) and allows users to be involved (Beresford, 2006).

4.2. Study setting, population and sampling

The study was conducted in the nursing school of an accredited publicly funded university in Ghana. There were approximately 527 nursing students and 16 full‐time faculty members. Like many educational institutions in developing countries, the school had challenges such as a lack of sufficient qualified faculty, and infrastructural and logistical constraints that may militate against assisting students to acquire CT skills. For example, class sizes could range from 50 to 150 students.

The study participants included students who had been enrolled in the degree nursing program for at least a year, nurse educators with current full‐time appointments with at least a year of teaching experience, preceptors and coordinators of CT‐based medical programs. It is believed that these participants had been associated with the nursing educational system long enough to provide rich data on their experiences and expertise. Furthermore, using diverse stakeholders in the study aided in providing balanced perspectives.

Twelve participants comprised 3 educators (with 1 being a coordinator of a CT‐based medical program), 2 preceptors, 6 students and the researcher himself were part of the cooperative inquiry group (CIG). Pertinent to the tenets of cooperative inquiry, these CIG were to collaboratively engage to develop a CT‐based curriculum framework. To select students for the CIG, presentations on the purpose and nature of the study were made in their respective classrooms. A list of those who agreed to participate in the study was compiled based on the different educational levels. Individuals were randomly selected and contacted through email or telephone. Similarly, a list of preceptors was obtained. In the Ghanaian context, preceptors are clinical nurses who instruct students during clinical placement. They were contacted and those who were willing to participate were ranked based on their educational level and experience. Two preceptors with Master's degrees in nursing were selected to participate in the study as their clinical experience and educational background provided the necessary expertise towards developing the CT‐based curriculum framework. Two educators were randomly selected while the coordinator of the CT‐based medical program (also an educator) was purposively invited through email and/or telephone. The CIG was engaged throughout the entire research process to identify ideas, observe, and reflect on results to develop a framework to foster CT skills of students. Seven steps of the research process evolved till the aim of the study was met. Different data sets—qualitative and quantitative—were gathered and analysed, culminating in the development of the framework.

4.3. Summary of research process

In this study, O'Leary's cycle of action research as described by Koshy et al. (2011) was adopted. The process alternates from observation, reflection and planning to action. Seven steps from observation to action were followed during the entire research project (see Figure 2). The cooperative inquiry group members were engaged throughout the seven steps of the research process. In total, three workshop meetings were held.

FIGURE 2.

FIGURE 2

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Summary of research process.

4.3.1. Step 1

Data were collected on the instructional practices/activities of the selected school from September 2017 to March 2018. These data sets were to aid the CIG in understanding current practices and to provide the baseline data for the development of the framework. Factors that either inhibited or enhanced perception/attention processing and comprehension of information and reflective judgement (analysing, evaluating and creating) according to Dwyer et al.'s (2014) were identified. Prior to data collection, the participants were exposed to the research methodology and methods at a training workshop held in September 2017. Nine participants—the first author (initiating researcher), two preceptors, one educator and five students—were able to attend this session. The first author introduced the CIG members to the Nominal Group Technique (NGT). The NGT is considered one of the most frequently used formal consensus building techniques (Harvey & Holmes, 2012). The NGT includes five stages, namely: (1) introduction and explanation, (2) silent generation of ideas, (3) sharing ideas—round robin, (4) group discussion/clarifying and (5) voting and ranking. Measures to ensure the rigour of inquiry were discussed and agreed upon. Two educators who were unable to attend the session were met individually and the purpose and methods of the study were discussed with them.

4.3.2. Step 2

The analysed data from step 1 were presented to the CIG members at a second meeting held in March 2018. Nine participants—three educators, two preceptors, three students and the first author—were present at this meeting. The CIG deliberated on the results obtained through group discussions facilitated by the first author. Upon reflection, CIG agreed that the data provided enough basis for a draft framework to be considered. Vital issues about instructional practices had been elicited.

4.3.3. Step 3

Following the reflection on the data, the CIG through the Nominal Group Technique (NGT) facilitated by the first author designed a draft framework. Three questions were formulated for the NGT session, namely, (a) What concept(s) should be included in the framework that will facilitate CT skills of nursing students? (b) How should these elements/components/concepts/variables be related? and (c) What should the structure of the framework be?

At the first stage of introduction and explanation of the NGT, purpose of the study, NGT procedure and the three questions for the NGT procedure were reiterated to provide all members with the same point of reference. At the second stage of the NGT, members were allocated 5 minutes to generate ideas for the framework. Seventy‐six concepts were generated. These concepts were collated at the third stage of the NGT process. The fourth stage saw the concepts discussed, their meanings sought and consolidated. Through consensus, some concepts or synonyms were removed, leaving a total of 45 concepts. For example, the concept learner replaced and/or represented similar concepts such as student and nursing students. Likewise, facilitators replaced educators and/or lecturers. The 45 concepts were further consolidated (categorized) into nine. These included learner (and associated characteristics), educator/facilitator (and associated characteristics), teaching methods/style, learning environment, institutional support, assessment, technology, review system and curriculum. At the final stage, the CIG members voted to rank the concepts in order of importance. Learner, facilitator, teaching methods, learning environment and assessment were the five most ranked concepts. The first author was tasked to develop the draft framework with the concepts and relationships for the CIG members to review individually and for subsequent evaluation by students and educators for its applicability. Accordingly, the draft framework was designed by the first author together with one of the CIG members and subsequently distributed to all CIG members for input.

The draft framework suggested that the teaching‐learning process needed to be a caring professional relationship between the learner and the facilitator. This relationship should be the heart of the curriculum. The draft framework included six concepts/components which included: (a) caring professional relationship; (b) facilitator; (c) learner; (d) learning environment; (e) outcome setting, system review and advocacy and (f) contextual dynamics.

4.3.4. Step 4

The draft framework was made available to six educators and eight students in the selected school to review/comment on its applicability. The following questions accompanied the draft framework: How applicable is this framework in facilitating CT skills of students? What do you believe are the strength(s)/weakness(es) of this framework? What concept(s) do you believe should be removed and/or added to the framework to make it more applicable? Three educators and six students evaluated the draft framework. Given that these groups of participants are part of the nursing school, their views about the applicability of the framework were important to consider when implementing the framework in a real‐life situation.

4.3.5. Step 5

The students' and educators' comments and critiques about the draft framework were carefully analysed thematically by the first author. The draft framework was evaluated as applicable by all participants (3 applicable, 6 very applicable). The reasons for their choices included that the framework was simple, realistic, comprehensive (essential factors included), improved relationships for easier communication, made the facilitator a role model, made the learner an active participant and the learner's view was encouraged. Considering the strengths of the framework, the evaluators thought the framework was well structured, bridged gaps in the learner–facilitator relationship, comprehensively covered most factors of education, and covered current trends, and legal/regulatory issues.

The following were seen as the weaknesses of the draft framework by the evaluators: (a) difficulty to elicit commitment from all; (b) challenges associated with the hard environment; (c) possibility of being misused by students; (d) possible failure of the authentic student–facilitator partnership; (e) perceived difficulty to explain complex concepts/processes such as outcome setting, advocacy, system review and (f) possible lack of CT skills of learners and facilitators. They also thought concepts like culture, time, students' involvement, external motivation and career counselling should be included in the framework.

4.3.6. Step 6

The results of the evaluation of the draft framework were presented to the CIG at a workshop facilitated by the first author in May 2018. The comments and critiques of the framework were reflected on by the CIG for possible revision. Eight participants—two preceptors, five students and the first author were present at this 5‐h workshop. The CIG members considered the weaknesses identified during the evaluation as rather systemic challenges in the selected school and not of the framework. In their view, a framework should represent the ideal. Also, the CIG members thought culture, time and students' involvement were already captured.

4.3.7. Step 7

A revised framework was designed to reflect the views of the evaluators of the draft framework. Some concepts/processes were fine‐tuned, and others were further explicated by the members (see Results section for more details). For example, the caring professional relationship was altered to authentic student–facilitator partnership. Likewise, more extended phrases were used to provide further explication to the facilitator, learner and learning environment. Through NGT, ownership was suggested and added to the definition of authentic student–facilitator partnership. The CIG held the assertion that ownership will enhance responsible learner and educator behaviour. The final framework is presented in the Results section.

5. RESULTS

The results from the cooperative inquiry were organized into a framework illustrating interconnected concepts required to foster CT skills of nursing students in developing countries. The framework proposes six key interconnected thematic priorities (see Figure 3) to drive the development of CT of students. The concepts/themes included in the final framework were (a) authentic student–facilitator partnership, (b) a facilitator that makes a difference, (c) a learner that is free to question and encouraged to reflect, (d) a conducive and participatory learning environment, (e) curriculum renewal processes and (f) contextual realities. These six concepts are important components that should drive a curriculum based on CT principles. The concepts which emanated from the CIG discussions are described below.

FIGURE 3.

FIGURE 3

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Critical thinking‐based curriculum for undergraduate nursing program.

5.1. Authentic student–facilitator partnership

The authors of this study suggest that the central focus of the teaching–learning process should be authentic partnership between the learner and the facilitator (Raymond et al., 2018). This view is motivated by the evidence of dysfunctional learner–facilitator relationships coupled with heightened students' perceptions of mistrust, lack of support, lack of emotional connectedness and lack of democratic practices informed by cultural realities identified (Boso et al., 2020, 2021c). These authors define authentic student–facilitator partnership as a supportive, empathetic, learner‐directed, mutually respectful, accountable and democratic learning relationship which focuses on assisting a learner to engage in meaningful learning experiences toward the development of CT skills.

It is suggested that the educator takes responsibility for the optimum functioning of this partnership (Billings & Halstead, 2005; Mangena & Chabeli, 2005; Raymond et al., 2017). However, both the student and the facilitator (Raymond et al., 2018) should feel a sense of ownership of the teaching and learning process. The findings of this study suggest that factors relating to both students and facilitators could either facilitate or inhibit the fostering of CT skills acquisition. Consequently, both the student and the facilitator should be committed to setting up appropriate boundaries to govern this partnership. These boundaries should include adherence to educational justice—creating equal opportunities, fair evaluation, fair criticism and non‐discrimination on the basis of gender, race or religious status (Boozaripour et al., 2018). Adherence to boundaries is likely to enhance the perception of trust and ownership.

5.2. A facilitator that makes a difference

We see the facilitator as the leader, role model, mentor and guardian of the student for a purposeful learning experience towards CT skills acquisition. It was evident in this study that the facilitator's approach to classroom management and general attitude towards students and cultural realities influenced how students engaged in the teaching and learning process (Boso et al., 2020, 2021c). Cultural competence in healthcare is a global standard; thus, the facilitator should be aware of the influence of cultural tendencies (Chan, 2013; Donkor & Andrews, 2011) on the student–facilitator partnership. The facilitator should become a role model in terms of how he/she collaborates and communicates (Raymond et al., 2018) as well as his/her punctuality to class. These general effective teaching tenets are required to set the tone for the reflective engagement of students towards the acquisition of CT skills. For example, a lack of punctuality will limit the amount of instructional time required for students to think critically. Also, the facilitator should demonstrate CT tenets in his/her teaching.

Furthermore, the facilitator needs to demonstrate scholarly attributes and experience in teaching, clinical skills, and theoretical nursing knowledge; be student‐centred, empathetic, supportive; and enthusiastic about the nursing profession and teaching (Billings & Halstead, 2005; Mangena & Chabeli, 2005; Raymond et al., 2018). The facilitator needs to connect with the learner on an emotional level (Raymond et al., 2018). It is proposed that the facilitator should use tools such as CT‐oriented learning outcomes/objectives, appropriate assessment for CT and active learning teaching approaches/methods. In addition, teaching and assessment methods should vary and should be driven by appropriate questioning techniques (Duron et al., 2006; Raymond et al., 2018). These questioning techniques should predominantly target higher‐order of thinking to help students to engage in appropriate thinking moments (Duron et al., 2006).

5.3. A learner that is free to question and encouraged to reflect

The learner is the inquirer/discoverer of knowledge guided by the facilitator in an educational program. It was noted in this study that students were influenced by the Ghanaian cultural realities (Boso et al., 2020, 2021c) that did not allow them to question authority (Donkor & Andrews, 2011) and the type of assessment/teaching methods to which they are exposed. These authors posit that to assist in fostering CT skills of learners, the students should not see themselves as a receptacle in which content/information is dumped, but rather as rational individuals who can decide for themselves regarding truth. Therefore, students should adopt CT‐oriented learning practices that ensure a reflective view of content/information for self‐determination and lifelong learning. This encourages facilitators to share their CT with students (Raymond et al., 2018). In addition, they should be encouraged to be self‐motivated and self‐directed.

Strategies needed to promote CT skills in students should include the use of CT‐oriented learning outcomes/objectives, appropriate assessment for CT and active learning teaching methods. Additionally, teaching and assessment methods should vary and should be driven by appropriate questioning techniques (Duron et al., 2006; Raymond et al., 2018) which should target higher order of thinking to help students to engage in appropriate thinking moments (Duron et al., 2006).

5.4. Conducive and participatory learning environment

The authentic student–facilitator partnership between the learner and the facilitator occurs in a conducive learning environment that promotes CT (Mangena & Chabeli, 2005; Raymond et al., 2018). This environment has two components: hard and soft. The hard environment involves a library, learning space and technology. Appropriate use of technology should be employed in the teaching–learning process. This study showed that students were engaged in distractive use of social media and technology in the classroom (Boso et al., 2020). Guidelines for the use of technology/social media should be available to help learners and facilitators derive maximum benefits from these tools. Also, institutional support is required for the provision of appropriate technology, learning space, appropriate class size and library resources for a meaningful learning experience (Raymond et al., 2017, 2018).

The soft environment involves the intangible safe, empathetic and democratic atmosphere created to encourage the learner to share his/her views freely. This conducive atmosphere should permeate the entire school environment. This helps to establish emotional connectedness between the students and other role players in the educational environment (Raymond & Profetto‐McGrath, 2005; Raymond et al., 2017, 2018). It was noted in this study that students did not feel adequately supported, and were not regularly engaged in curriculum reviews and other matters that directly affect their learning (Boso et al., 2021c). Consequently, we propose the establishment of a system of support (including financial aid) for students and practical avenues for students' engagements based on a consultative process involving students and other role players. Additionally, school managers should provide support to facilitators through staff development programs on CT. Assisting faculty development in the area of CT instructional methods will help educators to infuse CT tenets in their own courses (Mangena & Chabeli, 2005; Raymond et al., 2017, 2018). Measures such as assigning facilitators with teaching assistants should be adopted to give facilitators more time to engage in CT instructional practices (Shell, 2001). Facilitators in this study expressed the concern of inadequate time to engage students, partially due to the absence of teaching assistants.

5.5. Curriculum renewal processes

We propose that renewal processes should be adopted for a CT‐oriented curriculum as a whole and of parts as deemed necessary and considering local, national and international trends. The aim of these processes should be to encourage continuous feedback and review that will lead to curriculum improvement (Duron et al., 2006). Students and other role players should be engaged in the curriculum renewal processes. In reviewing the curriculum, contemporary CT assessment theory and practices should be used. Furthermore, the renewal process should adhere to the standards of curriculum review processes. Also, the relevance of courses should be continuously examined to ensure that they attract students' engagement towards CT skills. Consistent with CT activism tenets (Davies & Barnett, 2015), advocacy should be encouraged to effect changes that may be occasioned by observations from the curriculum review. Particularly, educators should be encouraged to engage in advocacy to effect changes that may be necessary to assist students to acquire CT skills.

5.6. Contextual realities

A curriculum does not exist in a vacuum. It should be designed and operated in a specific context (Billings & Halstead, 2005). The learning process and the extent to which one can address CT skills are influenced by contextual realities. These contextual realities include the program of study, the global/national trends and policies and legal/regulatory framework. For example, as an undergraduate nursing program, CT is highly recommended as a competency (World Health Organization, 2009). It is therefore suggested that CT should be taught as a course and teaching methods that support CT be infused into all courses of the program. Global and national trends and policies need to be considered. For example, international development goals, disease patterns and burdens, employer expectations and needs, international best practices and standards, and availability of health facilities and clinical staff for clinicaleducation should guide the curriculum. Additionally, legal/regulatory bodies' requirements need to be adhered to. In the Ghanaian under graduate nursing context, the requirements of the Ghana Tertiary Education Commission (formerly of the National Accreditation Board), the Nursing and Midwifery Council of Ghana and the university in which the program is undertaken would be essential to consider.

6. ETHICAL CONSIDERATIONS

Research Ethics Committee approveal was obtained from the Health Research Ethics Committee of Stellenbosch University (Ref. No. FS17/05/106) and the university in which the study was conducted (name withheld to ensure the anonymity of participants). Written permission was sought from the dean of the selected school. All participants including students, nurse educators and preceptors provided informed consent. Given that this was a PAR, the owner of the authorship and the findings were made explicitly clear to the participants as suggested by Mash (2014). The names and the contributions of participants were kept confidential and the group was supported by the researcher throughout the study.

7. LIMITATION OF THE STUDY

The quality of a PAR is dependent on how the initiating researcher can unmask and diffuse power differentials. The power relational challenges inherent in many studies may be perpetuated (Scotland, 2012). Given that a hierarchical situation and power inequalities could arise because of the involvement of students, the students' representation was increased to form half of the cooperative inquiry group. Also, training of the cooperative inquiry group was carried out to address coercion, collaboration and partnership. The Nominal Group Technique was adopted for decision‐making to ensure that no one's view was disproportionately rated above others. In addition, the absence of one or two members at different times may have influenced the flow and consistency of ideas generated.

8. CONCLUSION

Conducting a study with the purpose of developing a framework of CT development is appropriate for different reasons. Consistent with the context of this study where the seniority tradition exists which may negatively influence the student–faculty relationship, this curriculum framework emphasized the importance of authentic interaction between students and the faculty in facilitating the CT skills of students. The recommended framework derived may suggest a wider implication for nursing schools and universities to provide CT‐based continuous professional development programs for their nurse faculty. Additionally, the study findings may have implications for monitoring and evaluation activities with the view of improving standard setting and teaching–learning experiences of students.

Based on this study, it is envisaged that nurse educators, who play a pivotal role in nursing education, will find reasons to refine their instructional practices. Also, further research focussing on different contexts of CT in Ghana may be useful. Most importantly, this framework may provide direction for how a curriculum can be predicated on CT, thereby removing arbitrariness.

AUTHOR CONTRIBUTIONS

All the authors made substantial contributions to the manuscript. CMB, ASVDM and JG conceived and designed the study. CMB collected data, analysed and drafted the manuscript. ASVDM and JG supervised the study and made critical revisions to the paper.

FUNDING INFORMATION

No external funding.

CONFLICT OF INTEREST STATEMENT

We do not have any conflict of interest to report.

ACKNOWLEDGEMENTS

We wish to acknowledge Victor Angbah for assisting in data collection. We also express our gratitude to the study participants. Furthermore, we express our profound gratitude to the authority and staff of the educational institution used for this study.

Boso, C. M. , van der Merwe, A. S. , & Gross, J. (2023). Curriculum framework to facilitate critical thinking skills of undergraduate nursing students: A cooperative inquiry approach. Nursing Open, 10, 5129–5138. 10.1002/nop2.1748

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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