Critical thinking (CT) refers to one’s capacity to analyse information, assess its relevance, make reasonable judgements as well as appropriately interpret and apply it as a problem-solving technique (Fitri et al. 2025). It is defined as a:

The ability to think critically is essential to nursing because it provides nursing students with higher-order thinking skills, which enable them to formulate appropriate answers to problems and to act quickly (Tseng et al. 2022; Zhang & Chen 2021).

It is a mental activity that can be regularly practised and improved in the field of nursing. A nurse is unable to identify the patient’s problem due to the lack of CT skills. As nurses choose treatment methods and evaluate acquired data, CT is necessary to make quick and informed judgements (Abiogu et al. 2020). In order to execute safe care practices and respond appropriately and suitably to society’s health needs, nurses must be able to gather and critically evaluate information as well as think critically about it in a logical and objective approach (Butler 2020; Grecu 2023).

There are numerous points of view about what constitutes CT (Ma, Zhang & Luo 2021). Some make it as simple as calling CT excellent or superior thinking. Despite prolific publications on CT in nursing education, there is still an evidence gap on suitable facilitation strategies to promote this crucial skill (Towfik et al. 2023). As such, this article will focus on the implementation and evaluation of three facilitation strategies. The strategies included Socratic inquiry, reflection and argumentation. Socratic Inquiry describes a dialogic facilitation technique that uses questions and reflections to encourage investigation and CT (Williams & Zimmerman 2022) whereas reflection is a method in which one interacts with one’s thoughts, feelings and actions as well as the abstract basis that underlies them to gain insights into the process of change (Yang et al. 2022). The other pedagogical strategy is argumentation, which refers to a conversational, debate-based and logical activity to show that one or more arguments are persuasive by providing evidence to support or contradict the proposals (Meral, Şahin & Akbaş 2021).

In this study, a quantitative, quasi-experimental, one-group pretest-post-test research design was used to implement and evaluate Socratic inquiry, reflection and argumentation as CT facilitation strategies. The CT levels of nursing students were measured twice using the Holistic Critical Thinking Scoring Rubric (HCTSR); data were collected on two occasions, before and after the intervention. The subject matter that was taught was a part of the prescribed curriculum. As such, no students could be excluded from attending the lessons. The study therefore lacked a control group. The quasi-experiment fostered the collection of the students’ baseline CT competencies in the pretest and compared the findings to determine the effectiveness of the intervention with the post-test scores.

Quantitative data gathered from research participants were sorted and summarised using descriptive statistics. They enabled the researcher to examine the characteristics, behaviours and experiences of the participants (Nieswiadomy & Bailey 2018).

From the selected sample, 32 third-year Bachelor of Nursing and Midwifery students underwent the intervention at the selected HEI. Table 1 shows the demographic data of the sample. Five strata were used to classify the students’ ages. Stratum one was composed of one (3.12%) 18-year-old, who was the youngest of the group. Stratum two consisted of 16 (50.00%) students, ranging between the ages of 19 and 21. The third stratum ranged from age 22 to 25 and was composed of 11 (34.38%) students. Students aged 26 to 27 made up the fourth stratum and they were three (9.38%). In stratum five, there was one (3.12%) student who was the oldest of the entire sample at 28 years of age. The sample was female dominated with 22 (68.75%) female students and 10 (31.25%) male students. Of the 32 students that made up the sample, 30 (93.75%) had no previous higher education history and 2 (6.35%) had a history of previous higher education studies.

This research aimed to implement and evaluate the efficacy of Socratic inquiry, reflection and argumentation as pedagogies to facilitate CT. The results revealed that these three strategies are generally effective in enhancing CT. The results also showed that the sample was predominantly female, similar to prior research (Lotan 2019) displaying a male underrepresentation as is the case in a South African context with male students making up only 8% of the entire nursing student population (Shakwane 2022). These findings are globally prevalent, owing to the notion that nursing is a female profession (Bordelon et al. 2023, Gauci et al. 2022). As such, men are faced with stereotypical biases and discrimination, questioning of male nurses’ sexual orientation as well as limitations brought about by cultural and religious aspects which deem them unfit to practice nursing. These restrictions are further strengthened by socially influenced gender roles on what is considered a norm thus leading to dysfunctional and uncomfortable work environments (Aynaci & Gulmez 2019; Prosen 2022).

In a quasi-experimental study assessing the impact of an educational intervention, the results showed that women obtained relatively higher CT scores as compared to their male counterparts (López et al. 2020). Essentially because of the belief that women easily take up the caregiver role, because of childhood sociocultural influences, which is a characteristic that is proximally related to CT competency development (Liu et al. 2019). Additionally, previous studies have found age to play a significant role in CT, whereby younger students obtained relatively lower CT scores as compared to older students (Mousazadeh et al. 2021).

However, there being only two age outliers, students aged 18 and 28 rendered the age demographic unreliable as a source of variability. Only 2 of the 32 students had previously undergone higher education experience in this research. As such, the effect of this variable on CT was not assessed. However, previous studies have reported inconsistencies regarding the correlation between age and CT (Demir, French & Hand 2023). For instance, in a study aimed at determining the link between age and CT of students in the health sciences, the results did not demonstrate any statistically significant correlation (Wettstein et al. 2011).

Similarly, prior research has shown that previous educational experience may not only influence the implementation of CT facilitation strategies but may also be a hindrance to the facilitation of CT. As such, a solid link must be established between the conventional approach and traditional facilitation strategies so that students can fully comprehend what they are experiencing (Fernández-Peña et al. 2016). Pedagogically, prior research has primarily focused on strategies that lacked learner-centredness and active student participation, with limited facilitator-student interaction. As such, their approaches fell short of enhancing students’ CT capacity (López et al. 2020). Conversely, the strategies employed in this study foster maximum student participation, allowing them to question themselves and others while constructing their own knowledge. This collaborative approach promoted the sharing of ideas and thoughts, critical analysis of the self, the environment and others thus fostering meaningful learning and promoting CT.

In a scoping review by Westerdahl et al. (2022) the results demonstrated that the most commonly used approaches aimed at enhancing CT were solely facilitative in nature or used in conjunction with a Socratic approach, which was the case in this study. This accentuates the need for efforts that encourage active knowledge construction by students, instead of passive knowledge transmission from the educator to the students. Instead, the facilitator assumed positive and authoritative role-modelling, creating a safe learning sphere that allows the sharing of varying perspectives and aiding the students in shaping their own experiences. The results also showed that the pedagogical strategies employed in this study were effective in enhancing students’ CT overall. These results together with a two-sided p-value (p < 0.05), indicating statistical significance show that the intervention led to significant improvements in the students’ CT in both measurements. This is depicted in Table 2. Additionally, the results also showed a strong correlation between the scores obtained in the pretest and the post-test. Lastly, there was also a moderate effect size of the three strategies on the students’ CT skills (Table 3).

There is consensus on the significance of CT in higher education although there are still arguments as to how this essential skill is to be effectively facilitated (Bellaera et al. 2021). In this study, CT was facilitated using the infusion approach through which the students were taught CT and the learning content explicitly. Teaching CT along with the subject matter in this manner ensures retention of CT skills by students and also enhances students’ interest, motivation and desire towards the learning content (Orhan & Çeviker-Ay 2023). CT can also be facilitated through other approaches, the general, immersion and mixed approaches (Ennis 1989).

These categories differ based on the explicitness of how CT competencies are facilitated in relation to the learning content (Zhang & Yuan 2022). The generalist method is founded on the notion that CT skills bear interdisciplinary transferability. The immersion approach, similar to the infusion approach is based on the notion that CT is closely linked to domain knowledge, the distinction between the two approaches being that the immersion approach does not constitute explicit and direct teaching of CT skills. The mixed approach, on the other hand, constitutes the general approach with the immersion or the infusion approach (Orhan & Çeviker-Ay 2023; Wynekoop & Nakatani 2023).

Previous empirical results have demonstrated the efficacy of the infusion approach in CT instruction (Bensley & Spero 2014; Taghinezhad & Riasati 2020). Darby and Rashid (2017) also appraised the efficacy of the infusion approach on CT enhancement of engineering students through a quasi-experiment. The experimental group underwent the infusion approach whereas the control group underwent a conventional instruction method. Although the pretest results demonstrated no significant variability of CT skills in both groups, the post-test results demonstrated significantly higher CT skills in the intervention group as compared to the non-experimental group. There exists a close relationship between CT and the nursing process (Westerdahl et al. 2022) thus justifying the use of the nursing process learning content in the context of this study. The existence of this interrelatedness was emphasised by Wilkinson (2011), highlighting that CT is the impetus for the nursing process and that each step of this process constitutes CT. These steps include assessment, diagnosis, planning, implementation and evaluation (Souto et al. 2024).

The use of the nursing process as a problem-solving strategy in CT instruction fosters clinical decision-making (laslan et al. 2023). The results of this study in conjunction with previous empirical findings highlight that using nursing process-based scenarios for CT facilitation fosters theory and practice competency thus ensuring that the populace of students transitioning into registered nurses is adequately prepared to enter the nursing profession. This study also assessed nursing students’ CT competency to determine the differences between the pretest and post-test means. The results demonstrated the efficacy of the three pedagogical strategies employed, through statistically significant improvements overall (Table 3).

Despite the usage of the nursing process, which students start learning and gradually applying from the commencement of the course and continue within the industry, during the implementation phase of the study, students constantly sought clarity on what the facilitator expected of them. They struggled to explain or justify certain stances and there seemed to be a language issue, leading to students asking if they could use vernacular in expressing themselves. This may be attributed to the assertion that less than 10% of South Africans are native English speakers, which warrants a quality enhancement in pedagogical methodologies because the language of teaching is a second language to a large portion of the population (Manditereza 2014).

This observation showed partial consistency with previous studies. A study by Saputri and Rinanto (2018:1–6) evaluated students’ CT skills. The results showed that the students did not perform well in the explanation domain. This suggested that the participants could not strengthen their arguments because they merely offered descriptions that lacked the formation of rational links between concepts. Contrary to what explanation requires, this is the ability to clarify processes or causative relationships thus reinforcing their arguments. Putra, Prayitno and Maridi (2018) speculate that this can result from a lack of confidence that causes one to formulate inaccurate arguments.

The results of this study show the efficacy of Socratic inquiry, reflection and argumentation in facilitating CT. The recommendations for faculty and practice on fostering CT in nursing education and practice are provided. The employment of these pedagogical strategies is vital for knowledge creation as this will result in students and nurses who can think critically, with improved clinical competence and ultimately enhance patient outcomes.