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Developing Critical Thinking Using Think Aloud In Nursing Health Assessment

Poster 7

5/21/24, 9:30 PM

Critical thinking is a key component of competency-based curricula. The metacognitive strategy “Think Aloud” promotes critical thinking for nursing students learning new skills.

Maya Bastian

Minnesota State University Mankato


Metacognitive Strategies, Critical Thinking, Competence

As programs across the country move toward competency-based curricula, educators are exploring ways for students to learn and demonstrate the knowledge and skills needed to succeed. “Think Aloud” is a metacognitive strategy which aids in making thought processes explicit and conscious, promoting the development of critical thinking skills. This study investigated “Think Aloud” as an aid to undergraduate nursing students learning to perform health assessments. “Think Aloud” was used in demonstrations by the instructor and by the students during practice. “Think Aloud” is a metacognitive strategy that boosts student confidence and helps students develop critical thinking along with other skills.

Hear it from the author:

Developing Critical Thinking Using Think Aloud In Nursing Health Assessment


As nursing education shifts towards competency-based curricula, undergraduate
programs must find innovative strategies to cultivate students' clinical reasoning abilities
- the cornerstone of safe, effective patient care. This study explored the "Think Aloud"
metacognitive approach in our health assessment course for first-semester nursing
students at a Midwestern State University.

Expert nurses can identify and organize the key information needed to reach correct
nursing diagnoses. This process normally happens automatically and implicitly but
Think Aloud allows nursing students to explicitly hear how expert nurse instructors
organize and analyze patient information. It also aids nursing students’ learning as they
articulate what they are doing and why, and allows nursing instructors to understand
nursing students’ thought processes when they verbalize their developing clinical
reasoning with Think Aloud.

This study integrated Think Aloud for assessments of key body systems like
neurological and cardiovascular. While performance data was inconclusive, post-survey
results revealed overwhelmingly positive student experiences. They reported improved
understanding, retention, confidence, and ability to connect assessment actions to the
underlying rationale.

While limited by a single-course design, the findings align with evidence showing
metacognitive approaches effectively bridge the theory-practice gap in healthcare
education. As we strive to produce clinically adept, reflective practitioners, purposefully
incorporating innovative pedagogies like Think Aloud could be a powerful way to
scaffold students' critical thinking capabilities.

Altalhi, F., Altalhi, A., Magliah, Z., Abushal, Z., Althaqafi, A., Falemban, A., Cheema, E., Dehele, I., & Ali, M. (2021). Development and evaluation of clinical reasoning using ‘think aloud’ approach in pharmacy undergraduates – A mixed-methods study. Saudi Pharmaceutical Journal, 29(11), 1250–1257. 

Burbach, B., Barnason, S., & Thompson, S. A. (2015). Using “Think Aloud” to Capture Clinical Reasoning during Patient Simulation. International Journal of Nursing Education Scholarship, 12(1), 1–7. 

Kinyon, K., D’Alton, S., Poston, K., & Navarrete, S. (2021). Improving Physical Assessment and Clinical Judgment Skills without Increasing Content in a Prelicensure Nursing Health Assessment Course. Nursing Reports, 11(3), 600–607. 

Morgan, E. (2022). Student Success Through Mastery Learning in a Nursing Health Assessment Course. Journal of Nursing Education, 1–4. 

Pinnock, R., Young, L., Spence, F., Henning, M., & Hazell, W. (2015). Can Think Aloud Be Used to Teach and Assess Clinical Reasoning in Graduate Medical Education? Journal of Graduate Medical Education, 7(3), 334–337. 

Verkuyl, M., Hughes, M., & Fyfe, M. C. (2018). Using Think Aloud in Health Assessment: A Mixed-Methods Study. Journal of Nursing Education, 57(11), 684–686.

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