The mediating effect of critical thinking between interest in learning and caring among nursing students: a cross-sectional study

Nursing students must possess highly specialized competencies to accurately assess the state of patients and cope with potential problems. The requirements for nursing students vary from region to region, but there are some commonalities, as caring and critical thinking were identified as essential competencies [1]. Caring is the core of nursing practice, caring behavior varies in different societies and cultures [2]. Caring in nursing involves respect, support, and meeting patients’ needs [3]. The implementation of caring in clinical practice can not only benefit patients’ physical and mental health [4], but also improve nurse-patient relationships and enhance patients’ satisfaction [5]. Nurses who are trained in caring display greater problem-solving skills [6], are more satisfied in their jobs [4], and have a stronger sense of professional identity [6].

Critical thinking is closely related to nursing competence [7] and patient outcomes [8]. The undergraduate nursing curriculum and the core competencies of registered nurses emphasize critical thinking [9, 10]. To practice caring, nurse involve providing personalized nursing in response to the patients’ needs, which requires critical thinking skills [11]. Research on caring and critical thinking is not only concerned with concepts, influencing factors, but also explores the relationship between them [12, 13]. Researchers have found that caring and critical thinking are positively related both in western and oriental nursing students [11, 12]. Caring and critical thinking skills are not inherent, but can be developed. Nursing educators use a variety of teaching methods to foster caring and critical thinking in nursing students [14, 15]. Learning outcome is affected by interest in learning [16]. Learning is a process influenced by interest [17], and interest in learning will have a major impact on the way students learn [18]. The greater the interest of students, the better the learning outcomes will be [16]. The following conceptual framework was established based on the previous studies: 1) interest in learning is positively correlated with critical thinking, 2) interest in learning is positively correlated with caring, 3) critical thinking is positively correlated with caring, and 4) critical thinking is a mediator between interest in learning and caring.

Previous studies have explored the influence of interest in learning on caring and critical thinking, as well as the relationship between caring and critical thinking. However, the mediating effect of critical thinking in interest learning and caring among nursing students has not been clarified. The objectives of this study were to: 1) describe caring among nursing students in China and 2) examine the relationships among interest in learning, caring, and critical thinking.

The study followed the STROBE reporting guideline [19].

This study aimed to examine caring among nursing students in China and the relationships among interest in learning, caring, and critical thinking. Findings of this study generally supported the conceptual framework proposed in it. The results of the mediation analysis confirmed that critical thinking played a partially mediating role between interest in learning and caring among nursing students. The findings of regression showed that interest in learning had a significant impact on caring, which was similar to the results of previous studies [25‐27]. It is suggested that increasing nursing students’ interest in learning can be beneficial to their caring. Caring is not instinctive, but gradually grows and develops through learning and practice under the influence of both environment and education [28, 29]. The evidence is clear that students learn more when they are interested in the course [30, 31]. However, several studies have shown that nursing students’ caring does not change throughout their educational journey, and some studies even reported a decline [32, 33]. The two main components of caring are instrumental and expressive. Instrumental component is devoted to meeting physical and technical aspects of patients’ care, while expressive component involves meeting their psychological, social, and emotional needs [34, 35]. The existing educational system effectively promotes instrumental caring, while expressive caring calls for more efficient strategies [36, 37]. Critical thinking helps nursing students to perform expressive caring [38]. Nursing students who can demonstrate critical thinking have the ability to seek and examine information, and integrate information together to synthesize appropriate solutions [39]. Caring must begin by understanding the needs of patients, so that each patient can receive appropriate support according to their unique personalities [40]. Nursing students should use critical thinking in their practice of caring. Therefore, the effect of nursing students’ interest in learning on increasing caring maybe enhanced by strengthened their critical thinking.

The findings of this study revealed that interest in learning had an indirect positive effect on caring mediated by critical thinking. During this process, how does critical thinking come into play? Caring is the combination of purposeful nursing acts and attitudes designed to alleviate patients’ discomfort and meet their needs [41]. As part of the implementation of caring, it is imperative to collect and integrate all aspects of patient information in order to fully assess their condition and provide intervention accordingly [42]. Making decisions based on analysis and evaluation of problems requires critical thinking [43]. Critical thinking in clinical setting involves problem solving, caring, unbiased inquiry, intuition, and reflection in action [44]. Critical thinking enables both implicit and explicit information about the patient to be considered, as well as the integration of all useful information, so that caring can be accomplished. A positive correlation has been found between critical thinking and caring in previous studies [12]. Despite the fact that critical thinking cannot guarantee the practice of caring, it makes it possible to do so. Therefore, it is important to develop critical thinking among nursing students in order to cultivate their caring.

It was demonstrated that interest in learning was an important antecedent variable for nursing students to improve caring through critical thinking. The average score of critical thinking for nursing students in China was higher than the median in this study, indicating their critical thinking was at a medium level, but slightly lower than that of South Korean nursing students using the same instrument [45]. It is therefore suggested that courses focusing on caring should also introduce critical thinking as one of their learning outcomes in an effort to develop nursing students’ caring skills. The mediating role of critical thinking offers a new perspective for improving nursing students’ caring.

It adds to the literature on nurturing nursing students’ caring, but there are some limitations to the study. First, the findings were based on cross-sectional data, making it difficult to verify the causal relationship between variables. Future studies should employ longitudinal or experimental designs to clarify the relationship between these variables in more detail. Second, this study relied on self-reported questionnaires, resulting in an inevitable bias in information. To remedy this shortcoming, future research should focus on obtaining data using external tools such as classroom observations. Third, this study was conducted during the COVID-19 pandemic, which has significant implications for nursing students and nursing education. The results from this study should be interpreted with care once the pandemic has ended.

This study explored the little-studied topic of critical thinking and caring in nursing students, enriching the literature concerning nursing education. This study found that there was a significant relationship between interest in learning, critical thinking and caring. Importantly, this study revealed that students’ critical thinking played a mediating role in the relationship between interest in learning and caring, indicating that critical thinking may explain the relationship between interest in learning and caring.