How Demographic and Academic Factors Relate to Critical Thinking Skills among Indonesian Nursing Students

Gita Adelia; Esperanza Zuriguel Pérez; Eka Malfasari; Rizka Febtrina; Ulfa Hasana

doi:10.30994/jnp.v9i3.952

Authors

Gita Adelia Institut Kesehatan Payung Negeri Pekanbaru, Riau, Indonesia https://orcid.org/0000-0001-5916-9036
Esperanza Zuriguel Pérez Multidisciplinary Nursing Research Group, Vall d′ Hebron Research Institute (VHIR), Barcelona, Spain https://orcid.org/0000-0002-0622-8423
Eka Malfasari Institut Kesehatan Payung Negeri Pekanbaru, Riau, Indonesia https://orcid.org/0000-0002-8503-7691
Rizka Febtrina Institut Kesehatan Payung Negeri Pekanbaru, Riau, Indonesia
Ulfa Hasana Institut Kesehatan Payung Negeri Pekanbaru, Riau, Indonesia https://orcid.org/0000-0002-1483-6752

DOI:

https://doi.org/10.30994/jnp.v9i3.952

Keywords:

Academic Characteristics, Critical Thinking, Demographic Factors, Nursing Education, Nursing Student

Abstract

Background: Critical thinking is a core competency for nursing students because it supports clinical judgment, evidence-based practice, and patient safety. However, evidence on critical thinking among nursing students in Indonesia remains limited, and findings on the influence of demographic and academic factors are inconsistent.

Purpose: This study aimed to examine the relationship between demographic and academic characteristics and critical thinking levels among Indonesian nursing students.

Methods: This cross-sectional study was conducted at the largest private health education institution in Riau Province, Indonesia. Of the 400 eligible students, 365 completed the survey, resulting in an analyzable response rate of 91.3%. Data were collected using the Nursing Critical Thinking in Students Questionnaire (N-CT-4 Students), which consists of 109 items across four dimensions of the 4-Circle Critical Thinking Model. Data were analyzed using descriptive statistics, the Kruskal–Wallis test, and the chi-square test of independence.

Results: Nearly half of the respondents had a moderate level of critical thinking (48.2%). Inferential analysis showed that gender (χ² = 7.997; p = 0.018), educational program (χ² = 10.886; p = 0.004), academic year (χ² = 12.352; p = 0.015), and semester level (χ² = 12.352; p = 0.015) were significantly associated with critical thinking level. Age was not significantly associated with critical thinking level (H = 4.398; p = 0.111).

Conclusion: Most nursing students demonstrated a moderate level of critical thinking. Critical thinking was associated with gender and academic characteristics, whereas age was not. Nursing educators may strengthen critical thinking through case-based, reflective, and structured clinical learning strategies across the curriculum.

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References

Adelia, G., Alwi, F., Asyikin, N., Pérez, E. Z., Putri, V. D., Arfina, A., Locsin, R. C., & Yoder, L. H. (2026). Critical Thinking Skills Development Across Semesters in Nursing Students : A Cross-Sectional Study. Jurnal Berita Ilmu Keperawatan, 19(1), 83–94.

Adelia, G., Asyikin, N., Malfasari, E., Putri, V. D., & Arfina, A. (2024). Tingkat Berpikir Kritis Mahasiswa Keperawatan di Institusi Pendidikan Keperawatan Swasta. Jurnal Penelitian Perawat Profesional, 6(6), 3195–3200. https://jurnal.globalhealthsciencegroup.com/index.php/JPPP/article/view/7461/5022.

Aldiabat, K., Alsrayheen, E., Aquino-Russell, C., Al-Qadire, M., Al Rawajfah, O., & Al Sabei, S. D. (2021). Differences in critical thinking skills between nursing students on a fast-track versus traditional 4-year programme. British Journal of Nursing, 30(7), 434–439. https://doi.org/10.12968/bjon.2021.30.7.434.

Alfaro-lefevre, R. (2017). Critical Thinking, Clinical Reasoning, and Clinical Judgment: A Practical Approach (6th editio). Elsevier Inc.

Ali-Abadi, T., Babamohamadi, H., & Nobahar, M. (2020). Critical thinking skills in intensive care and medical-surgical nurses and their explaining factors. Nurse Education in Practice, 45(April 2019), 102783. https://doi.org/10.1016/j.nepr.2020.102783.

Ali, S., Alil, M., El-sayed, S. H., & Hosany, W. A. El. (2023). Effect of Critical Thinking Training Program on Improving knowledge and skills of Nursing Students at Technical Institute of Nursing. Trends in Nursing and Health Care Journal, 6(1), 1–9. https://doi.org/10.21608/tnhcj.2023.305024.

Azizi-Fini, I., Hajibagheri, A., & Adib-Hajbaghery, M. (2015). Critical Thinking Skills in Nursing Students: a Comparison Between Freshmen and Senior Students. Nursing and Midwifery Studies, 4(1), 1–5. https://doi.org/10.17795/nmsjournal25721.

Barry, A., Parvan, K., Jabbarzadeh Tabrizi, faranak, Sarbakhsh, P., Safa, B., & Allahbakhshian, A. (2020). Critical thinking in nursing students and its relationship with professional self-concept and relevant factors. Research and Development in Medical Education, 9(1), 7–7. https://doi.org/10.34172/rdme.2020.007.

Basco-Prado, L., Biurrun-Garrido, A., Zuriguel-Pérez, E., Roldán-Merino, J., & Mestres-Soler, O. (2024). Critical thinking level in nursing degree students according to sociodemographic and academic variables: A correlational study. Nurse Education in Practice, 78, 103955. https://doi.org/10.1016/j.nepr.2024.103955.

Bowers, M., Terry, D., & Irwin, P. (2025). The impact of reflective practice on nursing students : a scoping review. Nurse Education in Practice, 87, 104468. https://doi.org/10.1016/j.nepr.2025.104468.

Ciftci, B., Oktay, A. A., Erden, Y., & Kasikci, M. (2021). Comparison of Critical Thinking Levels of Nursing Students at Two Universities and the Influencing Factors. International Journal of Caring Sciences, 14(1), 1–664.

Esa, M., Karim, & Yaman. (2023). Critical Thinking Level among Nursing Students of Faculty of Medicine UKM. Medicine & Health, 19(1), 150–160. https://doi.org/10.17576/mh.2024.1901.10.

Ge, W. L., Zhu, X. Y., Lin, J. B., Jiang, J. J., Li, T., Lu, Y. F., Mi, Y. F., & Tung, T. H. (2025). Critical thinking and clinical skills by problem-based learning educational methods: an umbrella systematic review. BMC Medical Education, 25(1), 455. https://doi.org/10.1186/s12909-025-06951-z.

Geok, L. S., Yee, L. M., & Lian, H. A. (2019). Level of Critical Thinking Ability Among Nursing Students. Malaysian Journal of Nursing, 11(2), 31–39. https://doi.org/10.31674/mjn.2019.v11i02.004.

Hashish, A. A., Ebtsam, & Bajbeir, E. F. (2018). Emotional Intelligence among Saudi Nursing Students and Its Relationship to Their Critical Thinking Disposition at College of Nursing- Jeddah, Saudi Arabia. American Journal of Nursing Research, 6(6), 350–358. https://doi.org/10.12691/ajnr-6-6-2.

Jin, M., & Ji, C. (2021). The correlation of metacognitive ability, self-directed learning ability and critical thinking in nursing students: A cross-sectional study. Nursing Open, 8(2), 936–945. https://doi.org/10.1002/nop2.702.

Karaca, A. (2023). The Relationship between Critical Thinking Skills and Caregiving Roles of Nurses. Journal of Education and Research in Nursing, 20(4), 360–366. https://doi.org/10.14744/jern.2023.22354.

Kassabry, M., Al-Kalaldeh, M., Ayed, A., & Abu-Shosha, G. (2024). The impact of applying unfolding case-study learning on critical care nursing students’ knowledge, critical thinking, and self-efficacy; a quasi-experimental study. Nurse Education in Practice, 78(February 2024), 104015. https://doi.org/10.1016/j.nepr.2024.104015.

Kaya, H., Şenyuva, E., & Bodur, G. (2017). Developing critical thinking disposition and emotional intelligence of nursing students: a longitudinal research. Nurse Education Today, 48, 72–77. https://doi.org/10.1016/j.nedt.2016.09.011.

Liu, N. Y., Hsu, W. Y., Hung, C. A., Wu, P. L., & Pai, H. C. (2019). The effect of gender role orientation on student nurses’ caring behaviour and critical thinking. International Journal of Nursing Studies, 89, 18–23. https://doi.org/10.1016/j.ijnurstu.2018.09.005.

Mousazadeh, N., Momennasab, M., Nia, H. S., Nazari, R., & Hajihosseini, F. (2021). Effective Factors in Critical Thinking Disposition in Nursing Students. Education Research International. https://doi.org/https://doi.org/10.1155/2021/5580010.

Nemati-Vakilabad, R., Mojebi, M. R., Mostafazadeh, P., Jafari, M. J., Kamblash, A. J., Shafaghat, A., Abbasi, A. S., & Mirzaei, A. (2023). Factors associated with the critical thinking ability among nursing students: An exploratory study in Iran. Nurse Education in Practice, 73(June), 103814. https://doi.org/10.1016/j.nepr.2023.103814.

Nes, A. A. G., Riegel, F., Martini, J. G., Zlamal, J., Bresolin, P., Mohallem, A. G. da C., & Steindal, S. A. (2023). Brazilian undergraduate nursing students’ critical thinking need to be increased: a cross-sectional study. Revista Brasileira de Enfermagem, 76(1), 1–8. https://doi.org/10.1590/0034-7167-2022-0315.

Nguyen, T. V., Tang, M. F., Kuo, S. Y., Hu, S. H., Ngoc, T. D. T., & Chuang, Y. H. (2023). Nursing students’ critical thinking and associated factors in Vietnam: A multicenter cross-sectional study. Nurse Education in Practice, 73(October). https://doi.org/10.1016/j.nepr.2023.103823.

Nuampa, S., Ratinthorn, A., Tangsuksan, P., Chalermpichai, T., Kuesakul, K., Ruchob, R., Chanphong, J., Buranasak, J., Khadking, N., Subsomboon, K., Pangzup, S., Sirithepmontree, S., & Hungsawanus, P. (2025). Factors influencing critical thinking in simulation-based maternal-child nursing education among undergraduate nursing students: a mixed methods study. BMC Nursing, 24(1). https://doi.org/10.1186/s12912-025-03016-w.

Oh, J. A., Kim, E. A., & Kim, H. R. (2025). Influence of Critical Thinking Disposition, Clinical Reasoning Competence, and Nursing Practice Environment on Medication Safety Competence of Hospital Nurses. Healthcare (Switzerland), 13(5), 1–12. https://doi.org/10.3390/healthcare13050542.

Ruslan, A., & Ruslan, R. (2024). The Level of Critical Thinking Skills of Nursing Students at International Islamic University Malaysia (IIUM), Kuantan, Pahang. International Journal of Care Scholars, 7(3), 92–96. https://doi.org/10.31436/ijcs.v7i3.382.

Santos, M. J. de O., Lopes, J. P., Imaginário, C. I., Silva, H. S., & Morais, E. E. V. A. (2025). Influence of Demographic and Academic Variables on Portuguese Nursing Undergraduate Students’ Critical Thinking. Enfermeria Global, 24(1), 1–14. https://doi.org/10.6018/eglobal.624341.

Sari, D. W. P., Abdurrouf, M., Ardian, I., & Azizah, I. R. (2025). Investigating the factors influencing nursing students’ competency in patient safety. Healthcare in Low-Resource Settings, 13(s1), 143–147. https://doi.org/10.4081/hls.2025.13515.

Sun, Y., Yin, Y., Wang, J., Ding, Z., Wang, D., Zhang, Y., Zhang, J., & Wang, Y. (2023). Critical thinking abilities among newly graduated nurses: A cross-sectional survey study in China. Nursing Open, 10(3), 1383–1392. https://doi.org/10.1002/nop2.1388.

Wang, F., Liu, D., & Zhang, M. (2024). Metacognitive processes , situational factors , and clinical decision ‑ making in nursing education : a quantitative longitudinal study. BMC Medical Education, 24(1530). https://doi.org/10.1186/s12909-024-06467-y.

Yusuf, S. (2025). Contemporary Nursing As A Dynamic Response to Evolving Health Challenges. Indonesian Contemporary Nursing Journal, 10(1), 1–2. https://doi.org/https://doi.org/10.20956/icon.v10i1.46314.

Zainal, N. H., Islam, M. A., Rasudin, N. S., Mamat, Z., Hanis, T. M., Rodzlan Hasani, W. S., & Musa, K. I. (2025). Critical Thinking and Clinical Decision Making Among Registered Nurses in Clinical Practice: A Systematic Review and Meta-Analysis. Nursing Reports, 15(5), 1–19. https://doi.org/10.3390/nursrep15050175.

Zuriguel-Pérez, E., Falcó-Pegueroles, A., Roldán-Merino, J., Agustino-Rodriguez, S., Gómez-Martín, M. del C., & Lluch-Canut, M. T. (2017). Development and Psychometric Properties of the Nursing Critical Thinking in Clinical Practice Questionnaire. Worldviews on Evidence-Based Nursing, 14(4), 257–264. https://doi.org/10.1111/wvn.12220.

Zuriguel-Pérez, E., Lluch-Canut, M. T., Puig-Llobet, M., Basco-Prado, L., Almazor-Sirvent, A., Biurrun-Garrido, A., Aguayo-González, M. P., Mestres-Soler, O., & Roldán-Merino, J. (2022). The nursing critical thinking in clinical practice questionnaire for nursing students: A psychometric evaluation study. Nurse Education in Practice, 65(June), 1–7. https://doi.org/10.1016/j.nepr.2022.103498.