Document Type

Journal Article

Publication Title

Journal of Advanced Nursing



Place of Publication

United Kingdom


School of Nursing and Midwifery




This is an Author's Accepted Manuscript of: Jacob, E., Duffield, C., & Jacob, D. (2018). Development of an Australian nursing critical thinking tool using a Delphi process. Journal of advanced nursing, 74(9), 2241-2247. Available here.


Aim: To develop a critical thinking assessment tool for Australian undergraduate nurses. Background: Critical thinking is an important skill but difficult to assess in nursing practice. There are often many responses a nurse can make to a clinical problem or situation. Some responses are more correct than others and these decisions have an impact on a patient's care and safety. Differences in a response can relate to the depth of knowledge, experience and critical thinking ability of the individual nurse. Design: This study used a Delphi process to develop five clinical case studies together with the most appropriate clinical responses to 25 clinical questions. Method: The Delphi technique was undertaken using the Qualtrics survey tool between October 2016–January 2017. A panel of 13 nursing experts from various geographical locations in Australia participated in the study to review the case scenarios and answers to questions posed. Four rounds of participation were required to achieve a minimum of 80% agreement between participants. Participants were asked to rank answers for 25 multi-choice questions based on the correct nursing management of case scenarios provided and provide feedback as to the accuracy and relevance of the scenarios and answers. Results: Four rounds of Delphi questions were required to reach consensus on the correct wording and answers for the scenarios. Five case studies have been developed with nursing responses to patient management in rank order from most correct to least correct. Conclusion: Use of the tool should provide confidence that a nurse has met a certain level of critical thinking ability.



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