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BMC nursing
By Shehata YMM, Hendawi NE, Atta MHR and 3 others.
To evaluate the effect of the modified Know-Want-Learn-How-Apply-Questions (KWHLAQ) strategy on critical thinking and self-directed learning among third-semester undergraduate nursing students enrolled in a critical care nursing course.
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A quasi-experimental, nonequivalent control group pretest-posttest design was employed. One hundred undergraduate nursing students (n = 50 per group) enrolled in the Critical and Emergency Nursing Department, Faculty of Nursing, Alexandria University, participated during the 2025 academic session. The study group received a 12-week structured intervention based on the KWHLAQ framework; the control group received standard lecture-based instruction. Both groups completed the Critical Thinking Questionnaire (CThQ; α = 0.80) and the Self-Directed Learning Instrument (SDLI; α = 0.80) before and after the intervention.
After covariate adjustment, the study group demonstrated significantly higher post-intervention critical thinking scores than the control group (p < 0.05; Cohen's d = 0.67, moderate-to-large effect). The study group improved significantly in overall critical thinking (mean difference = 5.66; p < 0.01) and in the evaluating subscale (mean difference = 4.50; p < 0.001; Cohen's d = 2.10, whereas the control group's scores declined. Self-directed learning improved substantially in the study group (mean difference = 23.06; p < 0.001; Cohen's d = 2.45), with significant gains across all four SDLI subscales.
Integration of this structured, low-cost, and replicable pedagogical framework into nursing curricula may promote active learning, reflective reasoning, and clinical decision-making competencies essential for high-acuity practice.
Published in BMC nursing. The abstract is shown as published and remains the work of its authors; read the full article at the source.
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