The study purpose was to explore the critical thinking dispositions present among the final year BSc Nursing students in the various Colleges of Nursing, Pakistan.

What are the critical thinking dispositions present among final year BSc nursing students of various Colleges of Nursing in Pakistan?

A detailed literature review showed that promoting CTD was a neglected content in nursing education in Pakistan. The few studies that have been conducted on CT in Pakistan have focused on the curriculum at the school and college level [12] ; some on strategies enhancing CT in students [9] ; and one study focused on how CT is perceived and practiced by educators in higher education [12] . However, to the best of the researcher’s knowledge, this study will be the first study to explore the CT dispositions in nursing students of military colleges across the country.

Critical thinking, tracing its roots back to the eighteenth century [13] , gained specific terminology in 1989 [14] . Ancient philosophers like Socrates emphasized the importance of questioning, with Plato and Aristotle further defining it as a dialogue within the soul and a combination of abstract and moral reasoning [15] . Critical thinking has since been linked to reflective judgment, problem-solving, and the scientific method [4] . Its teaching began in kindergarten and was later emphasized in nursing education programs [12] , with ongoing global efforts to describe and teach this essential skill.

Delphi Survey, 1990: Various authors have provided definitions of critical thinking, reflecting its complex nature. This diversity led to confusion, prompting [16] to coordinate a consensus on the definition. The American Philosophical Association conducted a Delphi Survey, involving 46 experts from North America, resulting in a comprehensive definition. Critical thinking, as per this survey, encompasses a range of qualities, including curiosity, rationality, open-mindedness, honesty, and persistence [16] . Importantly, it integrates cognitive skills with affective dispositions.

The key factor in the interpretation of CT is that it is not a method but a process or, in other words, it is mind orientation encompassing the affective and cognitive domains [17] . Cognitive skills are necessary for judgment, by engaging in analyzing, interpreting, evaluating, and regulating self [7] ; whereas affective or personality attributes refer to dispositions or inclination, sensitivity, as well as the ability [17] .

The person is considered a critical thinker who is able to apply CT dispositions or habits of minds in his actions, beliefs and thoughts, which are determined judiciously.

Reference [16] , explained a person’s dispositions as follows:

Open-mindedness. The ability to appreciate different perspectives or willing to respect people having alternative opinions.

Inquisitiveness. Curiosity and enthusiasm in wanting to acquire information about working on things, even though the application is not required immediately.

Truth-Seeking. Possessing the courage to ask questions to gain knowledge, even if the knowledge obtained is against beliefs.

Analyticity. Analyzing and utilizing verified information with the application of reasoning to anticipate consequences.

Systematicity. Approaching different levels of complex problems with focus and diligence.

Self-Confidence. Trusting one’s thinking or decision making skills, which are rational or scientific, and respond to societal as well as individual values.

Maturity. Making timely decisions even when faced with complex situations and issues.

CT dispositions are highly regarded in nursing and have been extensively researched globally. Reference [18] conducted a literature review revealing differences in CTD between Asian and non-Asian nursing students. Among 795 articles reviewed, only 73 focused on nursing students’ CT skills and dispositions, with just 15 assessing CTD specifically. These studies highlighted a limited focus on CT dispositions in educational practices, with Asian students tending to score lower than their non-Asian counterparts.

Reference [19] , conducted a study in Egypt, finding a positive correlation between learning approaches and CTD in nursing students. The study recommended integrating diverse learning methods into the curriculum to enhance CT skills. However, many students showed low truth-seeking scores, possibly due to passive learning methods and reluctance to ask questions.

Educational trends in Pakistan still focus on teacher centered approaches and allow minimum amount of CT promotion in students [20] . This is supported by reference [21] , where they indicated that in the Pakistani education system, the main focus is on rote learning, where transfer of factual information is a priority and emphasis is on superficial knowledge, neglecting underlying meaning. Reference ( [20] , p. 131) states that teaching in Pakistan “heavily relies on dictation” and “examinations are the tests of memory” this particular issue is also signaled previously by various other scholars in Pakistan [22] [23] . Educational reforms are needed to “develop students, not as a memorizer of given information but as a searcher and explorer of the information” ( [24] , p. 2020).

Cultural stereotypes persist in education, with the expectation of complete silence in class reflecting respect for teacher authority [20] . This traditional approach has been criticized by Pakistani educationist [22] for hindering the development of critical thinking (CT) and logical reasoning skills. In Pakistan, institutions often limit CTD by emphasizing reverence for teachers as spiritual figures [20] .

Moreover, teachers themselves have limited knowledge about how to cultivate CT amongst students. The research survey conducted on 309 Turkish prospective teachers [25] , also highlighted that CT dispositions of teachers is at a medium to low level. Therefore, developing CTD of the educators first is very vital. Although, in Pakistan, there is awareness amongst educators regarding the need for a paradigm shift to modern educational strategies, but, as yet, this has not been achieved [26] [27] .

Educational institutes in Pakistan, focus on the rote learning [28] and teachers usually take the role of information givers rather than that of a facilitator [23] [29] [30] . Moreover, in the Pakistani educational system, classes are lecture-based, notes are dictated, and students listen to the lectures, with the purpose of enabling them to transmit textbook knowledge [20] . No study was found on nursing students of Pakistan that identified their CTD, especially in the military setting, where the education system is quite different from other colleges.

Purposive sampling was utilized to answer the research question and to recruit the study participants based on the inclusion criteria. Permission to gather data from six nursing colleges was obtained from the concerned authority and approval to conduct this study was taken from the Ethics Review Committee of the Aga Khan University, Karachi, Pakistan. Written informed consent was obtained from the nursing students for participation. Moreover, the privacy, confidentiality and anonymity of the participants was also maintained.

The sampling process involved obtaining lists of final year BSc nursing students from each college’s administration department. Study participants were then recruited from these lists, briefed about the study details, and selected based on predetermined criteria. Full time nursing cadets who were final year BSc Nursing Students were selected. The final sample size was two participants from each setting, which made a total of twelve participants. Appropriate data saturation was achieved at the tenth interview in this study. However, two additional interviews were carried out to ensure saturation.

Participant’s demographic data was gathered before conducting in-depth interviews exploring critical thinking dispositions in nursing students. Interviews were conducted in various locations, respecting participant preferences, and recorded with consent in both English and Urdu. Non-verbal cues were noted via field notes. Transcriptions of interviews were coded and securely stored, followed by content analysis to identify themes and categories. Relevant data was extracted and grouped into codes, refined through repeated recognition and revision. Themes were generated and interpreted, with literature review aiding in refinement. Conclusions were drawn, verified against existing literature, and supplemented by interview field notes.

The interview data focused on describing what is CT and CTD. Figure 1 depicts these two themes, categories, and their subcategories.

From the first theme, one category emerged: clarity of CT. which represents the students’ understanding of CT, and their attributes. In response to a question about what is CT, the participants gave various definitions. They defined CT, as problem-solving skills, management or handling of critical situations, decision making, analysis, deep rational thinking, and utilizing CT skills, such as intellect, evidence-based practice, exploring a problem, and reaching a conclusion. However, when participants were asked to define the attributes of a critical thinker, they were unable to differentiate between CT skills and dispositions, and some merged both the terms.

The second theme that emerged from different excerpts of the participants was experiences of CTD. It consists of four categories: truth-seeking, open-mindedness, inquisitiveness, and self-organization. The theme is described as follows:

The participants had an overall mixed and diverse understanding of CT and showed a lack of clear distinction between CT skills and dispositions which are consistent with the studies of reference [12] and [31] .

Participants shared four categories of CTD: truth seeking, open mindedness, inquisitiveness, and self-organization for the second theme. Three of the four categories, i.e., Truth Seeking, Open Mindedness, and Inquisitiveness are highlighted by reference [16] as CTD. Whereas, fourth one, self-organization attribute, seem to be directly related to as being organized and disciplined. This finding is supported by reference [32] , reinforces that nursing students’ CTD are directly related with their personal attributes as being organized.