اندازه گیری تفکر نقادانه دانشجویان مامایی: رهیافتی چند روشه Measuring critical thinking in pre-registration midwifery students: A multimethod approach

1. Introduction The provision of midwifery care is unique, multifaceted and complex and hence requires high level technical and cognitive abilities. There is increasing recognition that midwifery care leads to optimisation of outcomes for women and newborns (Renfrew et al., 2014; ten Hoope-Bender et al., 2014). To achieve these optimal outcomes, midwives are required to provide evidence-based, safe, and individualised care in partnership with women (Mènage, 2016a; Jefford et al., 2010). Hence, midwives need well developed cognitive skills to apply critical thinking in decision making using intellectual independence. However, there is limited literature focussing on thinking processes in midwifery practice (Mong-Chue, 2000). Critical thinking involves in-depth and higher order thinking that facilitates knowledge development, contextual decision making and problem solving skills, and analyses situations from different perspectives (Facione and Facione, 1996). Contextually appropriate decisionmaking is key to the provision of high quality and safe midwifery care (Jefford, 2012), and critical thinking is a crucial cognitive skill in reaching sound professional judgements. Midwifery decision making is holistic and made in partnership with women, requiring significant interpersonal skills, whilst acknowledging and valuing the woman’s autonomy to make informed choices (DavisFloyd, 2004; Mènage, 2016b; Jefford et al., 2010). Decisions need to be based on the best available evidence, however, whilst evidence, and the production of clinical guidelines, protocols and care pathways are proliferating, uncertainty remains regarding ‘best practice’ in many scenarios (Scholes et al., 2012). In addition, not all clinical guidelines or protocols are based on the best available evidence, and may be out-ofdate (Mènage, 2016b; Prusova et al., 2014). Similarly, there may be institutional barriers to the overt use of best practice guidelines, potentially limiting the midwife’s capacity to use those guidelines to inform decision making (Toohill et al., 2017).