critical analysis of a research paper in nursing

How to write a Critical Analysis in Nursing – Full Guide and Examples

How to write a Critical Analysis in Nursing

Nursing is a demanding and highly specialized field that requires critical analysis. Whether you are a new nurse or have been working in the field for years, writing a critical analysis can be daunting. In this article, we will show you how to write a critical analysis in nursing using a step-by-step process.

What is a Critical Analysis in nursing?

A Critical Analysis is a comprehensive, in-depth analysis of a text or piece of media. It can be used to explore the author’s intentions, analyze the plot, assess the characters, and determine the overall impact of the work.

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Why is it important to do a Critical Analysis?

Critical Analysis skills are essential for nurses as they work in both clinical and academic settings. They are also important for students who want to develop analytical skills and read critically. In addition, Critical Analyses provide nursing staff with insights into how other people have viewed a particular text or piece of media. This information can help nurses make informed decisions about patient care.

How do I do a Critical Analysis?

There is no one way to do a Critical Analysis. However, there are some key steps that you should take into account when undertaking this type of analysis:

1) Read the text or piece of media carefully;

2) Identify the main themes and ideas presented in the text;

3) Analyze these themes and ideas in depth;

4) Weigh each theme and idea against one another;

5) Write your analysis in an objective manner;

If you are a nursing student looking to learn how to write a critical analysis, you have come to the right place. In this article, we will teach you the basics of writing a critical analysis, including what to include and why. We will also provide some tips for how to structure your essay so that it is clear and easy to read. Finally, we will provide a sample critical analysis of a fictional novel to help you get started.

There are a few steps in writing a critical analysis of literature. In this article, we will discuss the different steps involved in writing a critical analysis and give you an example of how to go about it.

Step One: Choose Your Literature

The first step is to choose the literature you would like to analyze. This could be anything from a journal article to a novel. Once you have chosen your work, it is time to read it with an open mind. When reading any piece of literature, try to focus on the author’s purpose and message. Note what is important to them and how they communicate their ideas. After reading the work, take some time to formulate your thoughts about it in writing.

Step Two: Analyze the Text

Once you have formed your thoughts about the text, it is time to begin analyzing it. In order to do this, you will need to pay close attention to the author’s use of language and structure. Do they use specific words or phrases frequently? Why or why not? How does their choice of words affect their meaning? Are there any specific passages which stand out as particularly effective or ineffective? Once you have analyzed the text,write down your thoughts in a clear and concise manner.

Step Three: Evaluate the Theme and Ideas

Once you have analyzed the text, it is time to look at the main themes and ideas. What are they? What does the author want readers to take away from the work? Are the themes consistent throughout the text? How do the different themes connect? Once you have identified the main themes and ideas, write about them in your analysis. Do you think they are effectively communicated? Are there any elements of the text that you don’t agree with?

Step Four: Consider Your Opinion

After analyzing and evaluating the text, it is important to share your thoughts with readers. In writing a critical analysis, it is important to be objective. This means that you should not express your own opinions or biases in your writing. Instead, focus on providing readers with an objective perspective on the work. Is it worth reading? Why or why not? Is there anything else you would like to say about it?

How to format a Critical Analysis in Nursing

Critical analysis template.

Introduction

• Develop a topic sentence in which you will define the purpose of the Research Critique • Formulate a thesis statement which briefly provides a broad indication of your point of view in composing this assignment . • Include a summary outline to describe the organization and main topics you will include in the body paragraphs of the assignments (see below sections). Protection of Human Participants • Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? • Was informed consent obtained from the subjects or participants? • Did it seem that the subjects participated voluntarily in the study? • Was institutional review board approval obtained from the agency in which the study was conducted?

Data Collection • Are the major variables (independent and dependent variables) identified and defined? What were these variables? • How were data collected in this study? • What rationale did the author provide for using this data collection method? • Identify the time period for data collection of the study. • Describe the sequence of data collection events for a participant.

Data Management and Analysis • Describe the data management and analysis methods used in the study. • Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? • What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Findings / Interpretation of Findings: Implications for Practice and Future Research • What is the researcher’s interpretation of findings? • Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? • What limitations of the study were identified by researchers ? • Was there a coherent logic to the presentation of findings? • What implications do the findings have for nursing practice? For example, can the study findings be applied to general nursing practice, to a specific population, to a specific area of nursing? • What suggestions are made for further studies?

Conclusion • Emphasize the importance and congruity of the thesis statement • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Place your order now for a similar paper and have exceptional work written by our team of experts to guarantee you A Results.

Critical Analysis Essay Example Outline

Title: A critical analysis of a health promotion intervention: Diabetes effecting Schizophrenia patients

• A 2000 word essay based on a health promotion on Diabetes effecting Schizophrenia patients
• Activity that you have undertaken (or closely participated in) whilst on clinical placement.
• A rationale for the importance/necessity of the health promotion (hp) intervention that includes relevant epidemiological data and relates to contemporary health and/or social policy
• Application of a suitable health promotion model and/ or behaviour change theory to the activity undertaken.
• Critical consideration of health literacy in both the delivery of the health promotion activity and any supporting materials used.
• An evaluation of your health promotion activity.

• You need to demonstrate sound understanding of health promotion policy, evidence and theory related to your topic area. • You will not be able to address every health promotion theory, choose one model only and apply this to your topic; • Your essay should have a logical structure and have a systematic approach to care based on the Nursing Process. • Consider a paragraph for each concept and aspect of your essay.

Critical analysis requires objectivity and a critical perspective. It allows nurses to assess their own practice as well as the practices of others. To be effective, critical analysis must be structured and organized . The following steps can help you format a critical analysis:

1) Identify the purpose of the critical analysis. 2) Identify the literature that will be used in the analysis. 3) distill the information from the literature into a clear, concise, and objective statement. 4) Evaluate the strengths and weaknesses of the theory or practice being analyzed. 5) Suggest ways that the theory or practice could be improved.

The purpose of this critical analysis is to improve understanding of the strengths and weaknesses of a particular theory or practice used in nursing. The literature that will be used in this analysis includes both academic sources and clinical practice .

The information from the literature will be distilled into a clear, concise, and objective statement. The strengths and weaknesses of the theory or practice being analyzed will be evaluated. Suggestions for improving the theory or practice will be made.

How to write the introduction of a critical analysis paper

In order to write a successful introduction to your critical analysis paper, you must first establish the purpose of the paper. The purpose of this paper should be clear from the title and introduction, and should help to orient the reader towards your main points.

Once you have determined the purpose of your paper, you must introduce the reader to your main argument. You should begin by explaining why you believe that your chosen topic is important, and then provide evidence to support your claim. You may also want to mention any relevant historical or literary context, in order to give your argument a greater sense of resonance.

Finally, you should wrap up your introduction by stating how readers can use your paper as a blueprint for their own critical analysis work.

In conclusion, make sure that your introduction is concise and well-organized, so that readers will easily understand what lies ahead in the paper.

If you have any questions or would like help with writing your introduction, please don’t hesitate to reach out to one of our professional writers .

How to write the conclusion of a critical analysis paper in Nursing

The conclusion of a critical analysis paper in nursing is an important part of the paper. It should provide a summary of the main points made in the body of the essay, as well as give readers a sense of what the writer believes about the subject matter.

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It should also provide a suggestion for future research or teaching on the topic.

When writing a conclusion for a critical analysis paper, it is important to keep in mind the purpose of the essay.

The goal is not to provide an exhaustive review of all aspects of the subject matter, but rather to provide readers with an overview of what has been discussed and to offer some ideas for further exploration. This means that conclusions should be brief and to the point.

It is also important to remember that conclusions do not have to be original or unique. In fact, they can often be based on ideas that have been introduced throughout the essay.

Rather than coming up with new ideas on their own, it can be helpful to borrow from other sources when writing a conclusion.

This will help to ensure that your argument is sound and that readers will understand your position on the subject matter.

Nursing Concept Map example pdf on RSV Bronchiolitis/Bronchiolitis

When writing the conclusion of a critical analysis paper, it is important to be concise and to provide the reader with a clear understanding of your argument. Here are some tips on how to write a conclusion that meets these goals:

– Summarize your main points and support them with evidence. – State your conclusions clearly and concisely. – Offer a solution or recommendations for future research

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Reading and critiquing a research article

Nurses use research to answer questions about their practice, solve problems, improve the quality of patient care, generate new research questions, and shape health policy. Nurses who confront questions about practice and policy need strong, high-quality, evidence-based research. Research articles in peer-reviewed journals typically undergo a rigorous review process to ensure scholarly standards are met. Nonetheless, standards vary among reviewers and journals. This article presents a framework nurses can use to read and critique a research article.

When deciding to read an article, determine if it’s about a question you have an interest in or if it can be of use in your practice. You may want to have a research article available to read and critique as you consider the following questions.

Does the title accurately describe the article?

A good title will pique your interest but typically you will not know until you are done reading the article if the title is an accurate description. An informative title conveys the article’s key concepts, methods, and variables.

Is the abstract representative of the article?

The abstract provides a brief overview of the purpose of the study, research questions, methods, results, and conclusions. This helps you decide if it’s an article you want to read. Some people use the abstract to discuss a study and never read further. This is unwise because the abstract is just a preview of the article and may be misleading.

Does the introduction make the purpose of the article clear?

A good introduction provides the basis for the article. It includes a statement of the problem, a rationale for the study, and the research questions. When a hypothesis is being tested, it should be clearly stated and include the expected results.

Is a theoretical framework described?

When a theoretical framework is used, it should inform the study and provide a rationale. The concepts of the theoretical framework should relate to the topic and serve as a basis for interpreting the results. Some research doesn’t use a theoretical framework, such as health services research, which examines issues such as access to care, healthcare costs, and healthcare delivery. Clinical research such as comparing the effectiveness of two drugs won’t include a theoretical framework.

Is the literature review relevant to the study and comprehensive? Does it include recent research?

The literature review provides a context for the study. It establishes what is, and is not known about the research problem. Publication dates are important but there are caveats. Most literature reviews include articles published within the last 3 to 5 years. It can take more than a year for an article to be reviewed, revised, accepted, and published, causing some references to seem outdated.

Literature reviews may include older studies to demonstrate important changes in knowledge over time. In an area of study where little or no research has been conducted, there may be only a few relevant articles that are a decade or more old. In an emerging area of study there may be no published research, in which case related research should be referenced. If you are familiar with the area of research, review the references to determine if well-known and highly regarded studies are included.

Does the methods section explain how a research question was addressed?

The methods section provides enough information to allow the study to be replicated. Components of this section indicate if the design is appropriate to answer the research question(s).

• Did the researcher select the correct sample to answer the research questions and was the size sufficient to obtain valid results?
• If a data collection instrument was used, how was it created and validated?
• If any materials were used, such as written guides or equipment, were they described?
• How were data collected?
• Was reliability and validity accounted for?
• Were the procedures listed in a step-by-step manner?

Independent and dependent variables should be described and terms defined. For example, if patient falls in the hospital are considered the dependent variable, or outcome, what are the independent variables, or factors, being investigated that may influence the rate at which patient falls occur? In this example, independent variables might include nurse staffing , registered nurse composition (such as education and certification), and hospital Magnet &#174 status.

Is the analytical approach consistent with the study questions and research design?

The analytical approach relates to the study questions and research design. A quantitative study may use descriptive statistics to summarize the data and other tests, such as chi squares, t-tests, or regression analysis, to compare or evaluate the data. A qualitative study may use such approaches as coding, content analysis, or grounded theory analysis. A reader who is unfamiliar with the analytical approach may choose to rely on the expertise of the journal’s peer reviewers who assessed whether the analytical approach was correct.

Are the results presented clearly in the text and in tables and figures?

Results should be clearly summarized in the text, tables, and figures. Tables and figures are only a partial representation of the results and critical information may be only in the text. In a quantitative study, the significance of the statistical tests is important. The presentation of qualitative results should avoid interpretation, which is reserved for the discussion.

Are the limitations presented and their implications discussed?

It is essential that the limitations of the study be presented. These are the factors that explain why the results may need to be carefully interpreted, may only be generalized to certain situations, or may provide less robust results than anticipated. Examples of limitations include a low response rate to a survey, not being able to establish causality when a cross-sectional study design was used, and having key stakeholders refuse to be interviewed.

Does the discussion explain the results in relation to the theoretical framework, research questions, and significance of the study?

The discussion serves as an opportunity to explain the results in respect to the research questions and the theoretical framework. Authors use the discussion to interpret the results and explain the meaning and significance of the study. It’s also important to distinguish the study from others that preceded it and provide recommendations for future research.

Depending on the research, it may be equally important for the investigators to present the clinical and/or practical significance of the results. Relevant policy recommendations are also important. Evaluate if the recommendations are supported by the data or seem to be more of an opinion. A succinct conclusion typically completes the article.

Once you’re done reading the article, how do you decide if the research is something you want to use?

Determine the scientific merit of the study by evaluating the level and quality of the evidence. There are many scales to use, several of which can be found in the Research Toolkit on the American Nurses Association’s website http://www.nursingworld.org/research-toolkit.aspx . Consider what you learned and decide if the study is relevant to your practice or answered your question as well as whether you can implement the findings.

A new skill

A systematic approach to reading and critiquing a research article serves as a foundation for translating evidence into practice and policy. Every nurse can acquire this skill.

Louise Kaplan is director of the nursing program at Saint Martin’s University in Lacey, Washington. At the end of this article is a checklist for evaluating an article.

Selected references

Hudson-Barr D. How to read a research article. J Spec Pediatr Nurs . 2004;9(2):70-2.

King’s College D. Leonard Corgan Library. Reading a research article. http://www.lib.jmu.edu/ilworkshop08/materials/studyguide3.pdf . Accessed September 5, 2012.

Oliver D, Mahon SM. Reading a research article part I: Types of variables. Clin J Oncol Nurs . 2005;9(1):110-12.

Oliver D, Mahon SM. Reading a research article part II: Parametric and nonparametric statistics. Clin J Oncol Nurs . 2005;9(2):238-240.

Oliver D, Mahon SM. Reading a research article part III: The data collection instrument. Clin J Oncol Nurs . 2006;10(3):423-26.

Rumrill P, Fitzgerald S, Ware, M. Guidelines for evaluating research articles. Work . 2000;14(3):257-63.

15 Comments .

very helpful resource to critique any research article

I like it helped me a lot in my critical appraisal. thank you very much.

This article will help me with my understanding of how to read and critique a research article. This article was helpful in breaking down this information very basic to get a clear, concise understanding. Now I can take this information and go to the next level in my discussions

Great information and I will use this article for future reference.

This checklist and explanation for a literature review and/or reading and critiquing a research article was very helpful. As I only have 2 more classes to get my degree, I wish I knew this info 2 semesters ago! I will also pass this along to coworkers that will be going back to school in the near future.

Great article, I enjoyed the information. Thank You for this resource. Carolyn Martinez

Fantastic guide to the interpretation of clinical trials. Found this so helpful!

Great information and article. Thank you for the information.

well explained. its sometimes hard for P.G students to understand the concept but these guidelines are helpful to learn for novice.

This is great,am looking for guilgline on how to do research critique and this is just the solution.Thnks weldone

Unsure how to appropriately critique an article, thank you for your infomation

I am currently taking a Health Service Research course and was not sure how to sturcture my assignment. Thanks for posting this article!

very informative…very helpful to students doing research work.

Great timing; have just been asked to review and article and you provide the guide! Will share with colleagues.

I will be passing this article on to a friend who is taking a nursing research class. This article is a great reference for nursing students.

Comments are closed.

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Barker J, Linsley P, Kane R, 3rd edn. London: Sage; 2016

Ethical guidelines for educational research. 2018; https://tinyurl.com/c84jm5rt

Bowling A Research methods in health, 4th edn. Maidenhead: Open University Press/McGraw-Hill Education; 2014

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Critical Skills Appraisal Programme checklists. 2021; https://casp-uk.net/casp-tools-checklists

Cresswell J, 4th edn. London: Sage; 2013

Grainger A Principles of temperature monitoring. Nurs Stand. 2013; 27:(50)48-55 https://doi.org/10.7748/ns2013.08.27.50.48.e7242

Jupp VLondon: Sage; 2006

Continuing professional development (CPD). 2021; http://www.hcpc-uk.org/cpd

London: NHS England; 2017 http://www.hee.nhs.uk/our-work/advanced-clinical-practice

Kennedy M, Burnett E Hand hygiene knowledge and attitudes: comparisons between student nurses. Journal of Infection Prevention. 2011; 12:(6)246-250 https://doi.org/10.1177/1757177411411124

Lindsay-Smith G, O'Sullivan G, Eime R, Harvey J, van Ufflen JGZ A mixed methods case study exploring the impact of membership of a multi-activity, multi-centre community group on the social wellbeing of older adults. BMC Geriatrics. 2018; 18 https://bmcgeriatr.biomedcentral.com/track/pdf/10.1186/s12877-018-0913-1.pdf

Morse JM, Pooler C, Vann-Ward T Awaiting diagnosis of breast cancer: strategies of enduring for preserving self. Oncology Nursing Forum. 2014; 41:(4)350-359 https://doi.org/10.1188/14.ONF.350-359

Revalidation. 2019; http://revalidation.nmc.org.uk

Parahoo K Nursing research, principles, processes and issues, 3rd edn. Basingstoke: Palgrave Macmillan; 2014

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Critiquing a published healthcare research paper

Angela Grainger

Nurse Lecturer/Scholarship Lead, BPP University, and editorial board member

View articles · Email Angela

Research is defined as a ‘systematic inquiry using orderly disciplined methods to answer questions or to solve problems' ( Polit and Beck, 2017 :743). Research requires academic discipline coupled with specific research competencies so that an appropriate study is designed and conducted, leading to the drawing of relevant conclusions relating to the explicit aim/s of the study.

Relevance of research to nursing and health care

For those embarking on a higher degree such as a master's, taught doctorate, or a doctor of philosophy, the relationship between research, knowledge production and knowledge utilisation becomes clear during their research tuition and guidance from their research supervisor. But why should other busy practitioners juggling a work/home life balance find time to be interested in healthcare research? The answer lies in the relationship between the outcomes of research and its relationship to the determination of evidence-based practice (EBP).

The Health and Care Professions Council (HCPC) and the Nursing and Midwifery Council (NMC) require registered practitioners to keep their knowledge and skills up to date. This requirement incorporates being aware of the current EBP relevant to the registrant's field of practice, and to consider its application in relation to the decisions made in the delivery of patient care.

Advanced clinical practitioners (ACPs) are required to be involved in aspects of research activities ( Health Education England, 2017 ). It is for this reason that practitioners need to know how EBP is influenced by research findings and, moreover, need to be able to read and interpret a research study that relates to a particular evidence base. Reading professional peer-reviewed journals that have an impact factor (the yearly average number of citations of papers published in a previous 2-year period in a given journal is calculated by a scientometric index giving an impact factor) is evidence of continuing professional development (CPD).

CPD fulfils part of the HCPC's and the NMC's required professional revalidation process ( HCPC, 2021 ; NMC, 2019 ). For CPD in relation to revalidation, practitioners can give the publication details of a research paper, along with a critique of that paper, highlighting the relevance of the paper's findings to the registrant's field of practice.

Defining evidence-based practice

According to Barker et al (2016:4.1) EBP is the integration of research evidence and knowledge to current clinical practice and is to be used at a local level to ensure that patients receive the best quality care available. Because patients are at the receiving end of EBP it is important that the research evidence is credible. This is why a research study has to be designed and undertaken rigorously in accordance with academic and scientific discipline.

The elements of EBP

EBP comprises three elements ( Figure 1 ). The key element is research evidence, followed by the expert knowledge and professional opinion of the practitioner, which is important especially when there is no research evidence—for example, the most appropriate way to assist a patient out of bed, or perform a bed bath. Last, but in no way of least importance, is the patient's preference for a particular procedure. An example of this is the continued use of thermal screening dots for measuring a child's temperature on the forehead, or in the armpit because children find these options more acceptable than other temperature measuring devices, which, it is argued, might give a more accurate reading ( Grainger, 2013 ).

Understanding key research principles

To interpret a published research study requires an understanding of key research principles. Research authors use specific research terms in their publications to describe and to explain what they have done and why. So without an awareness of the research principles underpinning the study, how can readers know if what they are reading is credible?

Validity and reliability have long been the two pillars on which the quality of a research study has been judged ( Gliner and Morgan, 2000 ). Validity refers to how accurately a method measures what it is intended to measure. If a research study has a high validity, it means that it produces results that correspond to real properties, characteristics, and variations in the part of the physical or social world that is being studied ( Jupp, 2006 ).

Reliability is the extent to which a measuring instrument, for example, a survey using closed questions, gives the same consistent results when that survey is repeated. The measurement is considered reliable if the same result can be consistently achieved by using the same methods under the same circumstances ( Parahoo, 2014 ).

The research topic is known as the phenomenon in a singular sense, or phenomena if what is to be researched is plural. It is a key principle of research that it is the nature of the phenomenon, in association with the study's explicit research aim/s, that determines the research design. The research design refers to the overall structure or plan of the research ( Bowling, 2014 :166).

Methodology means the philosophy underpinning how the research will be conducted. It is essential for the study's research design that an appropriate methodology for the conduct and execution of the study is selected, otherwise the research will not meet the requirements of being valid and reliable. The research methods will include the design for data sampling, how recruitment into the study will be undertaken, the method/s used for the actual data collection, and the subsequent data analysis from which conclusions will be drawn (see Figure 2 ).

Quantitative, qualitative, and mixed-methods studies

A quantitative methodology is where the phenomenon lends itself to an investigation of data that can be numerically analysed using an appropriate statistical test/s. Quantitative research rests on the philosophical view that science has to be neutral and value-free, which is why precise measurement instruments are required ( Box 1 ). Quantitative research is influenced by the physical sciences such as mathematics, physics, and chemistry. The purpose of quantitative studies is to identify whether there are any causal relationships between variables present in the phenomenon. In short, a variable is an attribute that can vary and take on different values, such as the body temperature or the heart rate ( Polit and Beck, 2017 :748).

Quantitative studies can sometimes have a hypothesis. A hypothesis is a prediction of the study's outcome, and the aim of the study is to show either that the hypothesis is demonstrated as proven, or that it is not proven. Often a hypothesis is about a predicted relationship between variables. There are two types of variables, independent and dependent. An independent variable causes a change in the specific phenomenon being studied, while a dependent variable is the change in that phenomenon. The first example in Box 1 might help to clarify the difference.

An example of a hypothesis would be that older people who have a history of falls have a reduction in the incidence of falls due to exercise therapy. The causal relationship is between the independent variable— the exercise therapy—and the dependent variable—a falls reduction.

A qualitative methodology aims to explore a phenomenon with the aim of understanding the experience of the phenomenon from the perspective of those affected by it. Qualitative research is influenced by the social and not the physical sciences. Concepts and themes arise from the researcher/s interpretation of the data gained from observations and interviews. The collected data are non-numerical and this is the distinction from a quantitative study. The data collected are coded in accordance with the type of method being used in the research study, for example, discourse analysis; phenomenology; grounded theory. The researcher identifies themes from the data descriptions, and from the data analysis a theoretical understanding is seen to emerge.

A qualitative methodology rests on the philosophical view that science cannot be neutral and value-free because the researcher and the participants are part of the world that the research study aims to explore.

Unlike quantitative studies, the results of which can often be generalised due to the preciseness of the measuring instruments, qualitative studies are not usually generalisable. However, knowledge comparisons can be made between studies that have some similarity of focus. For example, the uncovering of causative or aggravating factors leading to the experiences of pain management for oncology patients, and for patients who have rheumatoid arthritis, or another long-term health problem for which pain is a characteristic feature. The validity of a qualitative study relates to the accurate representation of the data collected and analysed, and which shows that data has been saturated, meaning no new data or analysed findings are forthcoming. This is demonstrated in a clear data audit trail, and the study's findings are therefore seen as credible (see the second example in Box 1 ).

Box 1.Research study examples

• An example of a quantitative research study Kennedy and Burnett (2011) conducted a survey to determine whether there were any discernible differences in knowledge and attitudes between second- and third-year pre-registration nursing students toward hand-hygiene practices. The collected data and its subsequent analysis is presented in numerical tables and graphs, but these are supported by text explaining the research findings and how these were ascertained. For full details, see 10.1177/1757177411411124
• 2. An example of a qualitative research study Morse et al (2014) undertook an exploratory study to see what coping strategies were used by women awaiting a possible diagnosis of breast cancer. Direct quotes from the study participants appeared in the writing up of the research because it is a requirement of qualitative research that there be a transparent data audit trail. The research showed two things, both essential requirements of qualitative research. First, how the collected data were saturated to ensure that no data had been left inadequately explored, or that the data coding had been prematurely closed and, second, having captured the breadth and depth of the data findings, the researchers showed how the direct quotes were thematically coded to reveal the women's coping strategies. For full details, see 10.1188/14.ONF.350-359
• 3. An example of a mixed-methods study Lindsay-Smith et al (2018) investigated and explored the impact on elderly people's social wellbeing when they were members of a community that provided multi-activities. The study combined a quantitative survey that recorded participants' sociodemographic characteristics and measured participation in activities with a focus group study to gauge participants' perceptions of the benefits of taking part in the activities. For full details, see https://bmcgeriatr.biomedcentral.com/track/pdf/10.1186/s12877-018-0913-1.pdf

Sometimes a study cannot meet its stated research aims by using solely a quantitative or a qualitative methodology, so a mixed-methods approach combining both quantitative and qualitative methods for the collection and analysis of data are used. Cresswell (2013) explains that, depending on the aim and purpose of the study, it is possible to collect either the quantitative data first and analyse these, followed by the qualitative data and their analysis. This is an explanatory/exploratory sequence. Or the qualitative data may be collected first and analysed, followed by the quantitative; an exploratory/explanatory process. Whichever approach is used, the cumulative data analyses have to be synthesised to give a clear picture of the overall findings ( Box 1 ).

The issue of bias

Bias is a negative feature of research because it relates to either an error in the conceptualisation of the study due to the researcher/s adopting a skewed or idiosyncratic perspective, or to errors in the data analysis. Bias will affect the validity and reliability of a study, so it is important that any bias is eliminated in quantitative studies, or minimised and accounted for in qualitative studies.

Scientific and ethical approval

It should be noted that, before any research study proceeds, the research proposal for that study must have been reviewed and agreed to by a scientific and ethics committee. The purpose of a scientific and ethics committee is to see that those recruited into a study are not harmed or damaged, and that the study will contribute to the advancement of knowledge. The committee pays particular attention to whether any bias might have been introduced to a study. The researchers will have detailed the reason why the study is required, the explicit aim/s and purpose of the study, the methodology of the study, and its subsequent design, including the chosen research methods for the collection of the data (sampling and study recruitment), and what method/s will be used for data analysis.

A literature review is undertaken and the established (published) international literature on the research topic is summarised to highlight what is already known on the topic and/or to show any topic gaps that have not yet been researched. The British Educational Research Association (BERA) (2018) also gives guidance for research proposals that are deemed to be educational evaluation studies, including ‘close-practice’ research studies. Any ethical issues such as how people will be recruited into the study, the gaining of informed voluntary consent, any conflict of interest between the researcher/s and the proposed research topic, and whether the research is being funded or financially supported by a particular source will also have been considered.

Critiquing a published research paper

It is important to remember that a published paper is not the research report. It is a sample of the research report. The research author/s are presenting their research findings as a succinct summary. Only a passing mention might be made that ethical approval and voluntary informed consent were obtained. However, readers can be assured that all publications in leading journals with a good reputation are subject to an external peer review process. Any concerns about a paper's content will have been ironed out prior to publication.

It will be apparent that there are several particular research designs. The Critical Skills Appraisal Programme (CASP) provides online information to help the interpretation of each type of study, and does this by providing questions to help the reader consider and critique the paper ( CASP, 2021 ).

General points for critiquing a paper include the following:

• The paper should be readable and have explicit statements on the purpose of the research, its chosen methodology and design
• Read the paper thoroughly to get a feel for what the paper is saying
• Consider what the researcher/s says about any ethical issues and how these have been handled
• Look at how the data were collected and analysed. Are the explanations for these aspects clear? In a quantitative study, are any graphs or charts easy to understand and is there supporting text to aid the interpretation of the data? In a qualitative study, are direct quotes from the research participants included, and do the researcher/s show how data collected from interviews and observations were coded into data categories and themes?
• In a mixed-method study, how are the quantitative and qualitative analyses synthesised?
• Do the conclusions seem to fit the handling of the data's analysis?
• An important test of validity is whether the study's title relates well to the content of the paper and, conversely, whether the content reflect a corresponding match to the study's title.

Finally, remember that the research study could have been conducted using a different methodological design provided the research aims would still have been met, but a critique of the paper relates to what has been published and not what otherwise might have been done.

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Critical Appraisal

Use this guide to find information resources about critical appraisal including checklists, books and journal articles.

Key Resources

• This online resource explains the sections commonly used in research articles. Understanding how research articles are organised can make reading and evaluating them easier View page
• Critical appraisal checklists
• Worksheets for appraising systematic reviews, diagnostics, prognostics and RCTs. View page
• A free online resource for both healthcare staff and patients; four modules of 30–45 minutes provide an introduction to evidence based medicine, clinical trials and Cochrane Evidence. View page
• This tool will guide you through a series of questions to help you to review and interpret a published health research paper. View page
• The PRISMA flow diagram depicts the flow of information through the different phases of a literature review. It maps out the number of records identified, included and excluded, and the reasons for exclusions. View page
• A useful resource for methods and evidence in applied social science. View page
• A comprehensive database of reporting guidelines. Covers all the main study types. View page
• A tool to assess the methodological quality of systematic reviews. View page

• Access through RCN Library

• Chapter 5 covers critical appraisal of the literature. Access through RCN library

• Chapter 6 covers assessing the evidence base. Access through RCN library

• Section 1 covers an introduction to critical appraisal. Section 3 covers appraising difference types of papers including qualitative papers and observational studies. Access through RCN library

• Chapter 6 covers critically appraising the literature. Access through RCN library

• Access through RCN library

Book subject search

• Critical appraisal

Journal articles

• View article

Shea BJ and others (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions or both, British Medical Journal, 358.

• An outline of AMSTAR 2 and its use for as a critical appraisal tool for systematic reviews. View article (open access)
• View articles

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Academic writing: using literature to demonstrate critical analysis, kathleen duffy senior lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, elizabeth hastie senior lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, jacqueline mccallum senior lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, valerie ness lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow, lesley price lecturer, school of nursing, midwifery and community health, glasgow caledonian university, glasgow.

When writing at degree level, nurses need to demonstrate an understanding of evidence by summarising its key elements and comparing and contrasting authors’ views. Critical analysis is an important nursing skill in writing and in practice. With the advent of an all-degree profession, understanding how to develop this skill is crucial. This article examines how students can develop critical analysis skills to write at undergraduate degree level. It highlights some of the common errors when writing at this academic level and provides advice on how to avoid such mistakes.

Nursing Standard . 23, 47, 35-40. doi: 10.7748/ns2009.07.23.47.35.c7201

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Critical appraisal - Education: methods - Literature and writing - Student nurses - Study skills

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Postgraduate Nursing: Critical appraisal and Evaluation of research

• EndNote & referencing
• Academic writing
• Research & research methods
• Introduction to evidence-informed practice
• Asking a Clinical Question
• Types of Research & Levels of Evidence
• Searching for the Evidence
• Critical appraisal and Evaluation of research
• Searching and appraising evidence demonstration
• Journals & Journal Articles
• Grey Literature & Statistics
• Search Tips
• CINAHL Plus with Full Text
• Medline & PsycINFO
• Cochrane Library
• Clinical Governance
• Anatomy & Physiology Resources
• Drug Resources
• Clinical Education
• Contact and feedback

Introduction to critical appraisal and evaluation

The information you use in your research and study must all be credible, reliable and relevant. Part of the Evidence-Based Practice process is to critically appraise scientific papers, but in general, all the resources you refer to should be evaluated carefully to ensure their credibility.

How can you tell whether the resources you've found are credible and suitable for you to reference? To evaluate Information you have found on websites, see the video below and the box on using Internet sites. Journal articles and academic texts should at least have gone through a process of peer review (see the video about peer review on the Journals page of this guide).

Critical appraisal of scientific papers takes the evaluation to another level. Once you have asked the clinical question and searched for evidence, it's often not enough that you've checked for peer review if you want to find the very best evidence - it will ensure that studies with scientific flaws are disregarded, and the ones you include are relevant to your question.

In the Evidence-Based Practice process, and especially in the process of evaluating primary research (which hasn't been pre-appraised or filtered by others), we need to go beyond the usual general information evaluation and make sure the evidence we are using is scientifically rigorous. The main questions to address are:

• Is the study relevant to your clinical question?
• How well (scientifically) was the study done, especially taking care to eliminate bias?
• What do the results mean and are they statistically valid (and not just due to chance)?

For a more detailed look at Critical Appraisal, head to the Systematic Review Guide - Critical Appraisal and the Evidence-Based Practice Guide - Appraise.

Critical appraisal tools

Fortunately, there have been some great checklist tools developed for different types of studies. Here are some examples:

• The Joanna Briggs Institute (JBI) provides access to critical appraisal tools, a collection of checklists that you can use to help you appraise or evaluate research.
• Critical Appraisal Skills Programme (CASP) is part of Better Value Healthcare based in Oxford, UK. It includes a series of checklists , suitable for different types of studies and designed to be used when reading research.
• The Equator Network is devoted to Enhancing the QUAlity and Transparency Of health Research. Among other functions, they include a  Toolkit for Peer Reviewing Health Research   which is very useful as a guide for critically appraising studies.
• Critical Appraisal Tools (CEBM)  - This site from the Centre of Evidence Based Medicine includes tools and worksheets for the critical appraisal of different types of medical evidence.
• Understanding Health Research - is from the Medical Research Council in the UK. It's a very handy all-purpose tool which takes you through a series of questions about a particular article, highlighting the good points and possible problem areas. You can print off a summary at the end of your checklist

Critical appraisal tools from the NHS in Scotland links interactively to all sorts of resources on how to identify the study type and build your critical appraisal skills, as well as to tools themselves.

Critical reading and understanding research

A useful series of articles for nurses about critiquing and understanding types of research has been published in the Australian Journal of Advanced Nursing by Rebecca Ingham-Broomfield, from the University of New South Wales:

Ingham-Broomfield, R. (2014). A nurses' guide to the critical reading of research . Australian Journal of Advanced Nursing , 32 (1), 37-44. [Updated from 2008.]

Ingham-Broomfield, R. (2014). A nurses' guide to quantitative research . Australian Journal of Advanced Nursing, 32 (2), 32-38. 

Ingham-Broomfield, R. (2015). A nurses' guide to qualitative research . Australian Journal of Advanced Nursing, 32 (3), 34-40. 

Ingham-Broomfield, R. (2016). A nurses' guide to mixed methods research . Australian Journal of Advanced Nursing, 33 (4), 46-52. 

Ingham-Broomfield, R. (2016). A nurses' guide to the hierarchy of research designs and evidence . The Australian Journal of Advanced Nursing, 33 (3), 38-43. 

Evaluate internet resources

The website domain gives you an idea of the reliability of a website:

Critical appraisal resources

Introduction to Critical Appraisal -  This short video from the library at the University of Sheffield in the UK looks at the background to critical appraisal, what it is, and why we do it. A very useful introduction to the topic.

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This article has a correction. Please see:

• Correction: How to appraise quantitative research - April 01, 2019

• Xabi Cathala 1 ,
• Calvin Moorley 2
• 1 Institute of Vocational Learning , School of Health and Social Care, London South Bank University , London , UK
• 2 Nursing Research and Diversity in Care , School of Health and Social Care, London South Bank University , London , UK
• Correspondence to Mr Xabi Cathala, Institute of Vocational Learning, School of Health and Social Care, London South Bank University London UK ; cathalax{at}lsbu.ac.uk and Dr Calvin Moorley, Nursing Research and Diversity in Care, School of Health and Social Care, London South Bank University, London SE1 0AA, UK; Moorleyc{at}lsbu.ac.uk

https://doi.org/10.1136/eb-2018-102996

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Introduction

Some nurses feel that they lack the necessary skills to read a research paper and to then decide if they should implement the findings into their practice. This is particularly the case when considering the results of quantitative research, which often contains the results of statistical testing. However, nurses have a professional responsibility to critique research to improve their practice, care and patient safety. 1  This article provides a step by step guide on how to critically appraise a quantitative paper.

Title, keywords and the authors

The authors’ names may not mean much, but knowing the following will be helpful:

Their position, for example, academic, researcher or healthcare practitioner.

Their qualification, both professional, for example, a nurse or physiotherapist and academic (eg, degree, masters, doctorate).

This can indicate how the research has been conducted and the authors’ competence on the subject. Basically, do you want to read a paper on quantum physics written by a plumber?

The abstract is a resume of the article and should contain:

Introduction.

Research question/hypothesis.

Methods including sample design, tests used and the statistical analysis (of course! Remember we love numbers).

Main findings.

Conclusion.

The subheadings in the abstract will vary depending on the journal. An abstract should not usually be more than 300 words but this varies depending on specific journal requirements. If the above information is contained in the abstract, it can give you an idea about whether the study is relevant to your area of practice. However, before deciding if the results of a research paper are relevant to your practice, it is important to review the overall quality of the article. This can only be done by reading and critically appraising the entire article.

The introduction

Example: the effect of paracetamol on levels of pain.

My hypothesis is that A has an effect on B, for example, paracetamol has an effect on levels of pain.

My null hypothesis is that A has no effect on B, for example, paracetamol has no effect on pain.

My study will test the null hypothesis and if the null hypothesis is validated then the hypothesis is false (A has no effect on B). This means paracetamol has no effect on the level of pain. If the null hypothesis is rejected then the hypothesis is true (A has an effect on B). This means that paracetamol has an effect on the level of pain.

Background/literature review

The literature review should include reference to recent and relevant research in the area. It should summarise what is already known about the topic and why the research study is needed and state what the study will contribute to new knowledge. 5 The literature review should be up to date, usually 5–8 years, but it will depend on the topic and sometimes it is acceptable to include older (seminal) studies.

Methodology

In quantitative studies, the data analysis varies between studies depending on the type of design used. For example, descriptive, correlative or experimental studies all vary. A descriptive study will describe the pattern of a topic related to one or more variable. 6 A correlational study examines the link (correlation) between two variables 7  and focuses on how a variable will react to a change of another variable. In experimental studies, the researchers manipulate variables looking at outcomes 8  and the sample is commonly assigned into different groups (known as randomisation) to determine the effect (causal) of a condition (independent variable) on a certain outcome. This is a common method used in clinical trials.

There should be sufficient detail provided in the methods section for you to replicate the study (should you want to). To enable you to do this, the following sections are normally included:

Overview and rationale for the methodology.

Participants or sample.

Data collection tools.

Methods of data analysis.

Ethical issues.

Data collection should be clearly explained and the article should discuss how this process was undertaken. Data collection should be systematic, objective, precise, repeatable, valid and reliable. Any tool (eg, a questionnaire) used for data collection should have been piloted (or pretested and/or adjusted) to ensure the quality, validity and reliability of the tool. 9 The participants (the sample) and any randomisation technique used should be identified. The sample size is central in quantitative research, as the findings should be able to be generalised for the wider population. 10 The data analysis can be done manually or more complex analyses performed using computer software sometimes with advice of a statistician. From this analysis, results like mode, mean, median, p value, CI and so on are always presented in a numerical format.

The author(s) should present the results clearly. These may be presented in graphs, charts or tables alongside some text. You should perform your own critique of the data analysis process; just because a paper has been published, it does not mean it is perfect. Your findings may be different from the author’s. Through critical analysis the reader may find an error in the study process that authors have not seen or highlighted. These errors can change the study result or change a study you thought was strong to weak. To help you critique a quantitative research paper, some guidance on understanding statistical terminology is provided in  table 1 .

• View inline

Some basic guidance for understanding statistics

Quantitative studies examine the relationship between variables, and the p value illustrates this objectively.  11  If the p value is less than 0.05, the null hypothesis is rejected and the hypothesis is accepted and the study will say there is a significant difference. If the p value is more than 0.05, the null hypothesis is accepted then the hypothesis is rejected. The study will say there is no significant difference. As a general rule, a p value of less than 0.05 means, the hypothesis is accepted and if it is more than 0.05 the hypothesis is rejected.

The CI is a number between 0 and 1 or is written as a per cent, demonstrating the level of confidence the reader can have in the result. 12  The CI is calculated by subtracting the p value to 1 (1–p). If there is a p value of 0.05, the CI will be 1–0.05=0.95=95%. A CI over 95% means, we can be confident the result is statistically significant. A CI below 95% means, the result is not statistically significant. The p values and CI highlight the confidence and robustness of a result.

Discussion, recommendations and conclusion

The final section of the paper is where the authors discuss their results and link them to other literature in the area (some of which may have been included in the literature review at the start of the paper). This reminds the reader of what is already known, what the study has found and what new information it adds. The discussion should demonstrate how the authors interpreted their results and how they contribute to new knowledge in the area. Implications for practice and future research should also be highlighted in this section of the paper.

A few other areas you may find helpful are:

Limitations of the study.

Conflicts of interest.

Table 2 provides a useful tool to help you apply the learning in this paper to the critiquing of quantitative research papers.

Quantitative paper appraisal checklist

• 1. ↵ Nursing and Midwifery Council , 2015 . The code: standard of conduct, performance and ethics for nurses and midwives https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf ( accessed 21.8.18 ).
• Gerrish K ,
• Moorley C ,
• Tunariu A , et al
• Shorten A ,

Competing interests None declared.

Patient consent Not required.

Provenance and peer review Commissioned; internally peer reviewed.

Correction notice This article has been updated since its original publication to update p values from 0.5 to 0.05 throughout.

Linked Articles

• Miscellaneous Correction: How to appraise quantitative research BMJ Publishing Group Ltd and RCN Publishing Company Ltd Evidence-Based Nursing 2019; 22 62-62 Published Online First: 31 Jan 2019. doi: 10.1136/eb-2018-102996corr1

Read the full text or download the PDF:

Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Affiliations.

• 1 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group Quantitative Psychology (2017-SGR-269), University of Barcelona, Barcelona, Spain.
• 2 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group on Gender, Identity and Diversity (2017-SGR-1091), University of Barcelona, Barcelona, Spain.
• 3 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.
• 4 Multidisciplinary Nursing Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain.
• PMID: 33029860
• DOI: 10.1111/nup.12332

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.

Keywords: critical thinking; critical thinking attitudes; nurse education; nursing care; nursing research.

© 2020 John Wiley & Sons Ltd.

• Attitude of Health Personnel*
• Education, Nursing / methods
• Nursing Process
• Nursing Research / methods

Grants and funding

• PREI-19-007-B/School of Nursing. Faculty of Medicine and Health Sciences. University of Barcelona

• Open access
• Published: 13 November 2024

Investigate the state of critical thinking and its impact on moral courage and moral sensitivity; evidence from nurses’ perspective

• Shima Bordbar 1 ,
• Jamshid Bahmaei 2 ,
• Hamidreza Farhadi Rad 3 &
• Ali Reza Yusefi 4  

BMC Nursing volume  23 , Article number:  825 ( 2024 ) Cite this article

Metrics details

Critical thinking, moral courage, and moral sensitivity are among the topics that are widely considered today in response to turbulent and complex environments in organizations. The purpose of this study was to investigate the state of critical thinking and its effect on moral courage and moral sensitivity in nurses working in hospitals under Jiroft University of Medical Sciences in southern Iran in 2024.

This descriptive-analytical cross-sectional study was conducted on 385 nurses. The data collection tools were standard questionnaires of critical thinking, moral courage and moral sensitivity. Data were analyzed using t-test, ANOVA, Pearson’s correlation coefficient and multiple linear regression using SPSS23 software.

The average scores of critical thinking, moral courage, and moral sensitivity of the studied nurses were 188.16 ± 8.22 out of 450, 62.32 ± 7.45 out of 105, and 71.55 ± 6.39 out of 100, respectively, indicating the weak level of critical thinking and the average level of moral courage and moral sensitivity of nurses. Between moral courage ( p  < 0.001, r  = 0.574) and moral sensitivity ( p  < 0.001, r  = 0.611) with critical thinking, a statistically significant correlation was observed in the direct direction. Based on the results of multiple linear regression, the components of critical thinking, which include truth-seeking, inquisitiveness, analyticity, systematicity, self-confidence, cognitive maturity, and open-mindedness, respectively, were identified as predictors of moral sensitivity and moral courage ( P  < 0.001).

The critical thinking of the examined nurses was estimated at a weak level, and moral courage and moral sensitivity were estimated at a moderate level. Based on the results, there is a possibility that by improving critical thinking, the state of moral courage and moral sensitivity of nurses will improve. Therefore, it is suggested that the hospital managers provide an opportunity to improve the critical thinking status of nurses by holding related courses and workshops, so that by this means, we can witness the growth and improvement of their courage and moral sensitivity.

Peer Review reports

Introduction

Critical thinking is one of the types of thinking in the field of education, which is of special importance [ 1 ]. The skill of critical thinking is essential in today’s society, and a deficiency in this skill can limit individuals from effectively participating in communities [ 2 ]. Nowadays, critical thinking is not only accepted as a vital aspect of nursing but also suggested to be a distinctive way of processing information within the nursing field. This process is dependent on individual skills like intelligence, knowledge, creativity, experience, understanding, and logic [ 3 ]. Critical thinking is a complex mental process that seems to require cognition at high levels of learning and is used in nursing practice for clinical decision-making [ 4 ]. Nurses should have the skill to make decisions in high-risk clinical scenarios and a predisposition to enhance critical thinking skills [ 5 ]. A nurse with a keen interest in critical thinking can enhance her abilities, apply her expertise, and efficiently complete her duties by making precise and prompt judgments. One of the fundamental aspects of successful decision-making is intelligence [ 6 ]. Some studies show that nurses’ critical thinking can directly affect the safety and improvement of the patient’s condition [ 7 , 8 ]. Therefore, they must be able to understand changes in patients’ conditions, carry out nursing interventions independently, accurately follow medical orders, and prioritize nursing actions [ 7 , 8 ]. Furthermore, critical thinking application leads to the improvement of problem-solving efficiency, nursing judgment skills, and clinical service quality [ 9 ]. Gaining critical thinking skills in nursing is associated with positive outcomes such as patient-centered care, creativity, evidence-based practice, and professionalization in the field [ 10 ]. Nurses who apply critical thinking abilities while providing care exhibit increased assurance in their decision-making and are capable of justifying their choices [ 10 ]. Therefore, utilizing this skill is effective in making accurate clinical judgments and managing patients in critical and stressful situations [ 11 ]. This is why it is necessary to measure and examine the critical thinking status of nurses. Although today the importance of critical thinking and its impact on the quality of nursing care is not hidden from all educational officials and planners; The results of some studies show that nurses’ critical thinking ability is not at an optimal level [ 12 , 13 , 14 ]. The use of critical thinking seems to be a crucial element in helping nurses maintain professional ethics standards when dealing with challenging ethical dilemmas [ 15 ]. In this regard, it should be mentioned that before performing an ethical action, nurses must determine whether that action is reasonable and meaningful or not [ 16 ]. In this situation, they should follow a critical thinking process to make a decision [ 17 ]. Critical thinking is very important for nurses because it enables ethical action in ethical situations [ 18 ]. In the field of nursing practice, nurses with critical thinking are needed to be able to demonstrate expertise by helping with accurate evaluation and judgment in the process of solving nursing problems as the subject of ethical decision making [ 19 ].

Nurses are encountering intricate ethical and spiritual dilemmas more frequently as a result of their professional position and responsibilities [ 20 ]. Ethical dilemmas arise from the excessive treatment of terminally ill patients, unnecessary medical examinations, fraudulent behavior in test administration and reporting, inadequate care, unequal power dynamics among staff, lack of support from the organization, and the pain and distress caused by aggressive diagnostic and therapeutic interventions aimed at fulfilling the organization’s needs [ 21 , 22 ]. Also, the lack of number of nurses, the unequal power of the health team members, and the ineffectiveness of managers in such moral situations, caused nurses to face inappropriate moral conditions in hospital environments [ 23 ]. This is because nurses are often faced with conflicting values ​​and beliefs of other health care providers to do the right thing, and these challenges affect the delivery of quality nursing care [ 24 ]. In this situation, nurses, as moral agents, need moral courage and breadth of vision to properly manage moral dilemmas and professional commitment to patients [ 25 ]. Recent research in England and Ireland has demonstrated inadequacies in the healthcare delivery system [ 26 ]. High mortality rates and cases of patient neglect were observed in a hospital in England during a different research investigation [ 24 ]. In a study by Black, around 34% of nurses opted not to report the injury to the patient, despite being informed about it [ 27 ]. Considering the silence of health workers in front of these problems, the question comes to mind, why is there no courage to say that these things are not correct [ 26 ]. When a person is not able to perform the correct moral action, moral courage helps him to strive to achieve the ultimate goal regardless of the consequences and take the right action which is not easy to do, considering the moral principles [ 28 ]. Nurses with strong moral courage can apply ethical principles effectively in various clinical scenarios [ 28 ]. High moral courage from nurses leads to making the best decisions according to ethical principles in different clinical situations [ 29 ]. Conversely, nurses with low moral courage may lead to neglect patients’ emotions and feelings, lack of attention to their privacy, disregard for their self-esteem, and clinical mistakes [ 30 ]. In relation to moral courage, it should be explained that learning critical thinking can be the foundation for creating this courage [ 31 ]. Nurses who have the ability to think critically by applying logic and reasoning, posing key questions and analyzing all the information needed in the work environment, gain the courage to overcome fear and do the right thing based on moral beliefs, despite the existence of potential threats [ 29 ].

Effective moral behavior hinges on the comprehension of moral principles and the cultivation of moral sensitivity [ 32 ]. Moral sensitivity allows individuals to discern moral complexities and view them through an ethical perspective [ 33 ]. This sensitivity, which is a combination of a person’s awareness of moral dimensions such as tolerance, calmness, responsibility, and giving importance to moral issues, is reflected in a person’s concerns about acting for others and helps people to distinguish between right and wrong actions [ 9 ]. The moral sensitivity of nurses often plays an important role in fulfilling their professional responsibility and making ethical decisions. In other words, it is the first component to comply with ethics in nurses’ medical care and is considered as one of the criteria of nurses’ professional competence. Various studies show the effect of moral sensitivity on improving the moral performance of nurses and improving the therapeutic relationship between nurses and patients; For this reason, nursing education organizations should pay attention to this important goal in their planning [ 33 ]. The framework of nursing activity includes the commitment to care and being sensitive to the physical and emotional needs of patients. As a result, moral sensitivity and sense of responsibility in those who provide clinical care to patients based on ethical values ​​is of particular importance [ 34 ]. Moral sensitivity requires caregivers to be aware of and interpret the behaviors and verbal and non-verbal signs of patients to understanding their needs. Moral sensitivity and sense of responsibility are of particular importance for nurses, who provide care based on personal moral values [ 27 , 28 , 32 ]. In this regard, critical thinking, as the ability to think in a clear and logical way, can help the sensitivity of nurses in the moral dimension. The study conducted by Kim (2015) indicated that nurses in their work environment, by using logical judgment and solving problems derived from critical thinking, can face and manage ethically problematic situations more sensitively [ 35 ]. Also, the findings of Je’s study (2021) indicated that critical thinking can help nurses make ethical decisions in clinical situations [ 36 ].

Despite examining the variables of critical thinking, moral courage and moral sensitivity separately in past studies, the relationship between this type of thinking and the above ethical considerations among nurses has not been widely reported in the relevant literature. Considering the importance of critical thinking, moral courage, and moral sensitivity in increasing the performance and quality of nursing services, as well as conducting few studies in the field of simultaneous investigation of these three variables, therefore, this study aims to determine the state of critical thinking and its effect on moral sensitivity and moral courage. It was conducted in nurses working in hospitals covered by Jiroft University of Medical Sciences in southern Iran in 2024. It should be mentioned that this study is different from the few previous studies in terms of methodology and the use of regression analysis. Thus, in addition to examining the correlation between the main variables of the research using the correlation coefficient, in the present study, regression analysis was used to test the effect of critical thinking on moral courage and moral sensitivity. An issue that has not been paid much attention to in previous studies. The findings of this study, while helping to expand the knowledge about the investigated variables in the field of nursing, increase the knowledge of managers and policymakers of the health system about the impact of critical thinking on moral sensitivity and moral courage in the nursing community. Also, according to the main goal of this research, the findings can be the basis for planning to improve the sensitivity and moral courage of nurses.

Design and setting

This cross-sectional descriptive-analytical study was conducted in 2024 on nurses working in hospitals covered by Jiroft University of Medical Sciences (including six hospitals) in southern Iran.

Participants

The population of this study was made up of nurses working in the mentioned hospitals, and using the following formula [ 37 ] with an error level of 5%, the sample size was estimated to be 385 people.

In the formula presented above:

z = 1.96. d = 0.05.

In each hospital, the selection of nurses began by determining the number of nurses in each department. Subsequently, proportional stratified sampling was employed, and nurses were randomly chosen based on their personnel code using a table of random numbers. These selected nurses then participated in the study.

Inclusion criteria included work experience of at least one year in a hospital, having at least a bachelor’s degree, employment in clinical departments, and willingness to participate in the study. Exclusion criteria also include employment in administrative and non-clinical sectors (non-nursing-related employment), an unfortunate accident (death of a loved one, divorce, etc.) within the past month since the start of the study, and unwillingness to participate in the study.

Instruments

The data collection tool was a four-part questionnaire. The first part of the questionnaire contained the demographic characteristics of age, gender, marital status, type of employment, and work experience. The second part was the California Critical Thinking Disposition Inventory, which was created by Facione in 1990 [ 17 ]. This questionnaire has 75 questions ranging from completely agree (score 6) to completely disagree (score 1) and has seven subscales of truth-seeking (12 questions), open-mindedness (12 questions), analyticity (11 questions), systematicity (11 questions), self-confidence (9 questions), cognitive maturity (10 questions) and inquisitiveness (10 questions). Truth-seeking refers to a person’s understanding that everything exists in truth and an interest in finding the truth. Open-mindedness refers to a person’s ability to accept unfamiliar ideas, even if they don’t fully agree with them, and their readiness to consider new concepts. Analyticity means the examination of different events and facts and it indicates that a person acts with will to consider the advantages and disadvantages of decisions. Systematicity refers to the existence of a systematic method in one’s thinking and the ability to break down complex problems into smaller components. Self-confidence expresses individuals’ trust in their own judgments and finds a reason to be confident in themselves. Inquisitiveness is the concept of a person’s curiosity towards unknown subjects and solving complex problems. Finally, cognitive maturity expresses the power of judgment based on reasoning and logic and seeing issues from different angles [ 38 ]. According to the score range (75 to 450), the average score between 75 and 200 was classified as poor critical thinking, the average score between 201 and 325 as moderate critical thinking, and the average score between 326 and 450 as good critical thinking [ 17 ]. The questionnaire has a reliability coefficient of 0.62, and all subscales demonstrate construct validity with a strong positive correlation ranging from 0.60 to 0.65, as documented in a study [ 38 ].

The third part was the standard moral courage questionnaire of Sekerka et al. (2009) with 15 questions about moral agency, multiple values, endurance of threat, going beyond.

compliance and moral goal, which investigated the level of moral courage. Moral agency indicates a person’s ability to strive for correct action and moral behavior in response to interactions. The multiple values ​​dimension characterizes a person’s ability to choose a set of different values ​​during ethical decision making. Endurance of threat refers to a person’s action in the face of threat and fear. In the dimension of going beyond compliance, a person does not only consider the rules, but goes beyond the inner capacity and considers doing what is completely correct and ideal. The moral goal dimension indicates the use of goal-setting strategies to reach a way of supporting, helping, benefiting, and paying attention to others [ 39 ]. Each question in this questionnaire is given a score from 1 to 7 on a 7-point scale from never true to always true. According to the score range of 15 to 105, the average score of 15 to 45 shows low moral courage, the average score of 46 to 75 shows moderate moral courage, and the average score of 76 to 105 shows high moral courage [ 40 ]. The validity of the moral courage questionnaire in Mohammadi et al.‘s study in Iran has been confirmed with CVI = 0.81 and its reliability with Cronbach’s alpha coefficient of 0.85 [ 39 ].

The fourth part was Han et al.‘s (2010) standard moral sensitivity questionnaire [ 34 ]. This part of the questionnaire has 25 questions and three components of respect (8 questions), professional responsibility (8 questions) and ethical behavior (9 questions). The dimension of respect refers to valuing, admiring deeply, and showing attention to others, which in this study shows nurses’ respect for others, including patients, in the work environment. Professional responsibility is a part of the concept of professional ethics and refers to the duties that a person is responsible for according to the job position. Finally, ethical behavior refers to behavior that is judged in the context of social situations in any country and is compared with the generally accepted behavioral norms in that country [ 41 ]. Scoring in this questionnaire was given on a 4-point scale from completely disagree to completely agree and from 0 to 4. According to the score range of zero to 100, the average score of zero to 50, 51 to 75, and 76 to 100 was classified as low, medium, high moral sensitivity, respectively [ 41 ]. The validity of this questionnaire has been confirmed by Hoseini and colleagues in Iran with a score of 0.97 and its reliability with Cronbach’s alpha coefficient equal to 0.81 [ 41 ].

Procedures and statistical analysis

To collect data, one of the researchers (ARY) visited the investigated hospitals on different days of the week in morning, evening, and night shifts and distributed and collected questionnaires. In order to comply with ethical considerations, the entry of nurses into the study and filling out the questionnaire forms was done completely voluntarily and only if the individual wanted. After explaining the objectives of the project to the participants, the confidentiality of the answers was emphasized, and verbal consent was obtained from them, and then the questionnaires were distributed among the studied nurses and collected on the same day. Then the collected data were entered into SPSS version 23 software.

To investigate the correlation between the variables of critical thinking, moral courage, and moral sensitivity, as well as the correlation of these three variables with the age and work experience of nurses, Pearson’s correlation coefficient was used. T-test was used to examine the difference in the average score of the three main research variables according to gender and marital status. ANOVA test was used to investigate the difference in the mean score of critical thinking, moral courage and moral sensitivity of nurses based on the employment status variable. Finally, in order to investigate the simultaneous effect of different dimensions of critical thinking on moral courage and moral sensitivity, multiple linear regression was used. A significance level of 0.05 was considered.

The average age of the nurses participating in the study was 30.41 ± 8.15 years and most of them (62.60%) were in the age group of less than 30 years. The average work experience was 5.87 ± 4.29 years and most of them (77.14%) in the group had less than 10 years of work experience. 66.49% were female and the rest were men. Most of the studied nurses were in the project-based employment status (63.89%) and married (68.57%) (Table  1 ).

The average score of critical thinking, moral courage, and moral sensitivity of the studied nurses was 188.16 ± 8.22 out of 450, 62.32 ± 7.45 out of 105, and 71.55 ± 6.39 out of 100, respectively, which indicates the level of critical thinking was weak and the level of moral courage and moral sensitivity of nurses was moderate (Table  2 ).

Based on the results, a statistically significant correlation was observed between critical thinking with moral courage ( r  = 0.574 and P  < 0.001) and moral sensitivity of nurses ( r  = 0.611 and P  < 0.001). In this way, probably the nurses who had critical thinking had more moral courage and greater moral sensitivity (Table  3 ).

The results of multiple linear regression analysis to determine the simultaneous effect of different dimensions of critical thinking and demographic variables on the moral courage and moral sensitivity of the nurses showed that the significant variables in the model, which were determined using the Enter method, in the order of importance were truth-seeking, inquisitiveness, analyticity, systematicity, self-confidence, cognitive maturity, open-mindedness, employment status, age and work experience (for moral courage), and truth-seeking, inquisitiveness, analyticity, systematicity, self-confidence, cognitive maturity, open-mindedness, work experience, age, employment status, and gender (for moral sensitivity).

The β values ​​related to the influencing variables that indicate the priority of influencing moral courage and moral sensitivity are given in Table  4 . Also, this test showed that the coefficient of determination of the processed model (R 2 Adjusted) for moral courage and moral sensitivity is equal to 0.69 and 0.73, respectively. This means that 69% and 73% of the changes in the moral courage and moral sensitivity scores of nurses can be explained by the variables in the model. The linear equation of the score of moral courage and moral sensitivity of nurses can be explained by the variables in the model. This equation was obtained based on multiple regression analysis as follows:

Ya = 3.002 + 0.643 × 1 + 0.635 × 2 + 0.629 × 3 + 0.618 × 4 + 0.610 × 5 + 0.597 × 6 + 0.583 × 7 + 0.579 × 8 + 0.566 × 9 + 0.562 × 10

Yb = 3.196 + 0.721 × 1 + 0.716 × 2 + 0.708 × 3 + 0.696 × 4 + 0.685 × 5 + 0.677 × 6 + 0.672 × 7 + 0.666 × 8 + 0.659 × 9 + 0.651 × 10 + 0.647 × 11

Ya: The moral courage of nurses

Yb: The moral sensitivity of nurses

X 1 , 2 , 3,4,5,6,7,8,9,10,11 : Variables affecting moral courage and moral sensitivity of nurses (Table  4 ).

Based on the findings of the study, the average score of critical thinking was significantly different based on the variables of age ( p  = 0.004), gender ( p  = 0.01), and employment status ( p  = 0.01). Thus, the average score of nurses’ critical thinking increased with age. Also, critical thinking was more in female nurses (189.05 ± 8.63 out of 450) and with permanent employment status (189.26 ± 7.42 out of 450) than others. Also, the mean score of moral courage of nurses was significantly different based on the variables of age ( p  = 0.02) and work experience ( p  = 0.04). So that the average score of moral courage of nurses increased with increasing age and work experience. Also, the moral courage of married nurses (62.88 ± 7.05 out of 105) and with permanent employment status (63.12 ± 7.88 out of 105) was higher than others. Finally, the average moral sensitivity score of the examined nurses was significantly different based on the variables of age ( p  = 0.03), gender ( p  = 0.04), marital status ( p  = 0.03), work experience ( p  = 0.007), and employment status ( p  = 0.04). In this way, the average moral sensitivity of nurses increased with age and work experience. Also, the moral sensitivity of female nurses (71.93 ± 6.34 out of 100), married nurses (72.08 ± 6.47 out of 100) and with permanent employment status (72.16 ± 6.35 out of 100) was higher than others (Table  5 ).

Based on the results, the critical thinking of the studied nurses was estimated at a weak level. In Hasanpour et al.‘s study (2016), the average critical thinking score of nurses was lower than the desired level [ 42 ]. In the review study by Ebadi et al. (2012), the results of the studies have shown that the level of critical thinking skills of graduate nurses is low [ 12 ]. The findings of the study by Babamohammadi et al. (2018) also indicated that the critical thinking score of nurses in internal surgery and special departments was weak [ 13 ]. The results of Karimi et al.‘s study (2013) also indicated the weak critical thinking ability of most clinical nurses [ 14 ]. Also, in the study of Kerman Saravi et al. (2011), the level of critical thinking of first year, fourth year nursing students and clinical nurses was reported to be weak [ 43 ]. The review of studies in the review article by Khandan et al. (2020) also shows that nursing students have a weak ability to understand critical thinking and their attitude is shaky [ 44 ]. Therefore, the results of all the mentioned studies are the same as the results of this part of the findings of the present study. In this regard, it can be stated that the reasons are the lack of professional independence of nurses in Iran and the reliance on the implementation of medical orders, as well as the absence or lack of nursing care based on the nursing process, which requires the ability to think logically; It has led to the weak ability of critical thinking in nurses. The educational approaches in schools and pre-university settings, along with the standard university programs, could be inhibiting the advancement of critical thinking abilities. Also, maybe the way of teaching in schools and before entering the university and the common educational programs being implemented during the university study period are such that it hinders the development of critical thinking.Based on part of the results of the study by Davari Dolatabadi and Ziaeirad (2021), the average critical thinking score of nurses had a favorable level [ 45 ]. The results of the study by Jafari et al. (2019) showed high critical thinking in the nurses participating in the study [ 46 ]. The results of the studies mentioned are incongruent with the findings of this part of the current study, and this inconsistency may be linked to factors such as the distinct research setting, tools employed, and participant entry and exit conditions.

The findings of the present study also showed that the average moral courage of the investigated nurses is at a moderate level. Studies by Mohammadi et al. (2014) [ 39 ], Hoseini et al. (2019) [ 47 ], Aminizadeh et al. (2017) [ 48 ], Moosavi et al. (2017) [ 49 ], Taraz et al. (2019) [ 50 ], Hannah et al. (2011) [ 51 ], and Safarpour et al. (2020) [ 52 ] have reported the level of moral courage in nurses at a moderate level. Therefore, the results of the mentioned studies are in line with the results of this part of the findings of the present study. Factors such as limitations in management and organization, poor institutional leadership, and non-adherence to professional standards are among the reasons for the moderate moral courage displayed by nurses. The majority of nurses demonstrate honesty in their work; however, various obstacles such as organizational structures often compel individuals to inhibit their ethical inclinations before taking action. On the other hand, the results of the study by Khajevandi et al. (2020) indicated that the average moral score of the nurses under study was high [ 53 ]. Namadi et al.‘s study (2019) has shown that the moral courage of nurses has a favorable level [ 54 ]. Mahdaviseresht et al.‘s study (2014) also reported the level of moral courage of nurses as favorable [ 40 ]. The results of these mentioned studies are inconsistent with the results of this part of the findings of the present study. The reasons for the difference in the moral courage of nurses in different studies can be considered to be the difference in organizational culture, the support of nurses and managers of the organization, the importance of job retention and the fear of being rejected. Also, this difference in the results can be caused by the environmental factors of the nurses’ workplace and different tools for measuring moral courage.

According to the results of this study, the average moral sensitivity of nurses was also at the moderate level. The results of studies by Izadi et al.(2013) [ 55 ], Chaloner(2007) [ 56 ], Abbaszadeh et al.(2010) [ 57 ], Hassanpoor et al.(2011) [ 58 ], Jaafarpour and Khani (2012) [ 59 ], Kobrai et al. (2021) [ 60 ], Mostafavian et al. (2019) [ 61 ], and Sharifi et al. (2020) [ 62 ], and Hosseinabadi et al. (2020) [ 63 ] showed that nurses have a moderate level of moral sensitivity. Therefore, the results of the mentioned studies are consistent with the results of this part of the present research. However, some studies have reported different results. Zuzelo (2007) in a study he conducted in the United States, reported the moral sensitivity of nurses as high [ 64 ]. Filipova (2009) showed that nurses do not have enough moral sensitivity to make decisions [ 65 ]. In the study of Kim et al. (2005), the mean moral sensitivity score of average nurses was reported to be high [ 66 ]. In the explanation of this part of the study, it can be stated that the average level of moral sensitivity of nurses indicates the relative importance given by nurses to complying with ethical principles in providing care to patients. In this regard, Ahn (2010) stated that nurses usually have a sense of responsibility and moral sensitivity, but the main moral difference between them is in adhering to this sensitivity in challenging situations [ 67 ]. Therefore, it is very important for nurses to become familiar with the principles of nursing ethics. The moral sensitivity of nurses is likely to be impacted by a combination of factors, including cultural influences, working environment conditions, educational background, ethics training, nursing workload, and patient volume.

Another part of the findings of the present study showed that there is a positive and significant correlation between critical thinking and moral courage and moral sensitivity of the studied nurses. This means that nurses with high critical thinking had higher moral courage and moral sensitivity. Based on the findings of Lim’s (2016) study, moral sensitivity and critical thinking were among the factors affecting perceived moral trust in nursing students under study [ 68 ]. Taghavi et al.‘s study (2022) showed a positive correlation between moral sensitivity and moral courage [ 69 ]. According to the results of Dehghani et al.‘s study (2017), one of the most important factors that facilitate compliance with ethics in nursing is the ability to think critically [ 15 ]. However, in the study of Ahn and Yeom (2014), a negative correlation was observed between moral sensitivity and critical thinking [ 70 ], which is contrary to the results of the present study; One of the reasons for this difference can be the target population and sample of the two studies. Also, Ahn and Yeom (2014) focused on final-year nursing students who, according to the authors, had not yet completed their ethics courses [ 70 ].

Marquis and Huston (2012) have listed critical thinking skills as one of the skills needed by supervisors [ 71 ]. In the clinical field, nurses are frequently confronted with unpredictable, urgent, and anxiety-inducing situations, requiring prompt, brave, and ethical decision-making. In the clinical field, nurses are faced with unpredictable, urgent, and anxiety-provoking situations every moment, which require immediate, timely, and courageous decision-making taking into account ethical criteria. Therefore, nurses must have critical thinking skills to overcome these problems and make brave decisions [ 71 ]. Unfortunately, nursing graduates are not able to think and make independent and appropriate decisions to solve patients’ problems and face critical cases, and most of the time they are unquestioning executors of doctors’ orders, which can lead to providing undesirable care to patients. Currently, there is a need for nurses who can provide multidimensional and specialized care in diverse and often unfamiliar environments, nurses who can deal with these complex changes with high levels of thinking and reasoning power. In addition, the uncertain and changing conditions of patients require that nurses are decision-makers with enough courage to be able to respond to the needs of their patients [ 72 ].

One of the limitations of this study is the quantitative methodology and data collection through questionnaires, which can affect the findings’ limitations and weak generalizability. Conducting qualitative research related to the study’s topic and also the use of structural equations modeling in examining the relationships between three variables can partially address this limitation, as it may reveal new dimensions of hidden and unexpressed findings. Another limitation of the present study is its cross-sectional design, so caution should be taken in generalizing the results.

The low level of critical thinking of nurses in this study indicates that the nurses under investigation have not received the necessary and sufficient training in the field of skills and knowledge of the concept of critical thinking. On the other hand, the existence of restrictive rules and guidelines has prevented the development of critical thinking and its components, including increasing decision-making power, self-confidence and growth, as well as the ability to analyze information in nurses. Nurses who do not use critical thinking skills in their care have less self-confidence in the decision-making process and cannot defend their decisions. Also, the average levels of variables of moral courage and moral sensitivity in the studied nurses indicate that moral issues are relatively important for nurses in facing the problems of patients. It can be manifested by nurses through supporting, promoting, and maximizing health and ability, preventing illness and injury, facilitating recovery, and alleviating the pain and suffering of patients. Finally, the positive and significant correlation between the variables of the research indicates that nurses who have critical thinking skills have more sensitivity and precision in their clinical and care decisions in dealing with patients and have the courage to make decisions. They have more suitable ways to improve the health level of patients.

Data availability

All the data is presented as a part of tables or figures. Additional data can be requested from the corresponding author.

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Acknowledgements

This research was extracted from a research project approved by the Jiroft University of Medical Sciences (ID: 853). The researchers would like to thank all the nurses who contributed to completing the questionnaires.

This work was supported by Jiroft Universiy of Medical Sciences, Jiroft, Iran with gant number:853.

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Shima Bordbar

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Jamshid Bahmaei

Student Research Committee, Jiroft University of Medical Sciences, Jiroft, Iran

Hamidreza Farhadi Rad

Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran

Ali Reza Yusefi

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ARY was designed the study and prepared the initial draft. ARY and SB are contributed in data collection and data analysis. JB and HF have supervised the whole study and finalized the article. All authors have read and approved the manuscript.

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Correspondence to Ali Reza Yusefi .

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This study is approved by Jiroft University of Medical Sciences Ethics Committee with the ID number of IR.JMU.REC.1402.032. All the methods were carried out in accordance with relevant guidelines and regulations. Meanwhile, the informed consent was obtained from all the study participants.

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Bordbar, S., Bahmaei, J., Rad, H.F. et al. Investigate the state of critical thinking and its impact on moral courage and moral sensitivity; evidence from nurses’ perspective. BMC Nurs 23 , 825 (2024). https://doi.org/10.1186/s12912-024-02496-6

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Received : 30 August 2024

Accepted : 05 November 2024

Published : 13 November 2024

DOI : https://doi.org/10.1186/s12912-024-02496-6

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