Integrating Higher-Order Thinking Skills into Hemodialysis Nursing Education

Abstract

The increasing complexity of healthcare services requires nurses to possess advanced cognitive competencies, particularly Higher-Order Thinking Skills (HOTS), including critical thinking, problem-solving, and creative thinking. These skills are essential for clinical decision-making, especially in specialized clinical environments such as hemodialysis units, where patient conditions often require continuous assessment and rapid clinical judgment. However, the integration of HOTS-based educational approaches in hemodialysis nursing education remains limited.

This study employed a descriptive cross-sectional design to explore the implementation of a HOTS-based nursing education approach in a hemodialysis clinical learning setting. The participants consisted of 13 nursing learners undergoing clinical practice in a hemodialysis unit, selected using a total sampling technique. Data were collected using a structured HOTS questionnaire consisting of 41 items measuring three domains: critical thinking skills, problem-solving skills, and creative thinking skills. Each item was assessed using a four-point Likert scale ranging from poor to very good. Descriptive analysis was used to summarize the respondents’ characteristics and the distribution of HOTS indicators.

The findings indicated that the implementation of a HOTS-based educational approach in the hemodialysis clinical learning environment supported the development of higher-order cognitive abilities among nursing learners. Participants demonstrated the ability to analyze patient complaints, interpret laboratory findings, identify clinical problems, and generate alternative nursing interventions in response to changing patient conditions. These competencies reflect the development of critical thinking, problem-solving, and creative thinking skills required for effective clinical practice.

Integrating HOTS into hemodialysis nursing education may strengthen nursing learners’ cognitive competencies in clinical reasoning and decision-making. The implementation of HOTS-based learning strategies has the potential to enhance the preparedness of nurses in managing complex patient conditions in specialized clinical settings.