Investigation of divergent thinking among surgeons and surgeon trainees in Canada (IDEAS): a mixed-methods study.

OBJECTIVE: To assess the creative potential of surgeons and surgeon trainees, as measured by divergent thinking. The secondary objectives were to identify factors associated with divergent thinking, assess confidence in creative problem-solving and the perceived effect of surgical training on creative potential, and explore the value of creativity in surgery. DESIGN: We used a mixed-methods design, conducting a survey of divergent thinking ability using a validated questionnaire followed by two semi-structured interviews with top-scoring participants. PARTICIPANTS & SETTING: Surgeons and surgeon trainees in the Department of Surgery at McMaster University. OUTCOMES: The primary outcome was divergent thinking, assessed with the Abbreviated Torrance Test for Adults. Participants also self-assessed their confidence in creative problem-solving and the effect of surgical training on their creative potential. We performed descriptive analyses and multivariable linear regression to identify factors associated with divergent thinking. We conducted a thematic analysis of the interview responses. RESULTS: 82 surgeons and surgeon trainees were surveyed; 43 were junior trainees and 28 were senior trainees. General surgery, orthopaedic surgery and plastic surgery represented 71.9% of the participants. The median participant age was 28 years (range 24-73), 51.2% of whom were female. Participants demonstrated levels of divergent thinking that were higher but not meaningfully different from the adult norm (62.39 (95% CI 61.25, 63.53), p<0.001). While participants scored significantly higher than the average adult on fluency (the ability to produce quantities of ideas) and flexibility (the ability to process information in different ways) (p<0.001 for both), they scored below average on originality (the ability to produce uncommon, new or unique ideas) (p<0.001). Regression analysis identified higher divergent thinking scores among females (estimated ß=-3.58 (95% CI -6.25 to -0.90), p=0.010). CONCLUSIONS: The divergent thinking ability among surgeons and surgeon trainees was not meaningfully different from the adult normative score; however, their ability to generate original ideas was below average.

Using Concurrent Complication Reporting to Evaluate Resident Critical Thinking and Enhance Adult Learning.

OBJECTIVE: Critical thinking and accurate case analysis is difficult to quantify even within the context of routine morbidity and mortality reporting. We designed and implemented a HIPAA-compliant adverse outcome reporting system that collects weekly resident assessments of clinical care across multiple domains (case summary, complications, error analysis, Clavien-Dindo Harm, cognitive bias, standard of care, and ACGME core competencies). We hypothesized that incorporation of this system into the residency program's core curriculum would allow for identification of areas of cognitive weakness or strength and provide a longitudinal evaluation of critical thinking development. DESIGN: A validated, password-protected electronic platform linked to our electronic medical record was used to collect cases weekly in which surgical adverse events occurred. General surgery residents critiqued 1932 cases over a 4-year period from 3 major medical centers within our system. These data were reviewed by teaching faculty, corrected for accuracy and graded utilizing the software's critique algorithm. Grades were emailed to the residents at the time of the review, collected prospectively, stratified, and analyzed by post-graduate year (PGY). Evaluation of the resident scores for each domain and the resultant composite scores allowed for comparison of critical thinking skills across post-graduate year (PGY) over time. SETTING: Data was collected from 3 independently ACGME-accredited surgery residency programs over 3 tertiary hospitals within our health system. PARTICIPANTS: General surgery residents in clinical PGY 1-5. RESULTS: Residents scored highest in properly identifying ACGME core competencies and determining Clavien-Dindo scores (p < 0.006) with no improvement in providing accurate and concise clinical summaries. However, residents improved in recording data sufficient to identify error (p < 0.00001). A positive linear trend in median scores for all remaining domains except for cognitive bias was demonstrated (p < 0.001). Senior residents scored significantly higher than junior residents in all domains. Scores > 90% were never achieved. CONCLUSIONS: The use of an electronic standardized critique algorithm in the evaluation and assessment of adverse surgical case outcomes enabled the measure of residents' critical thinking skills. Feedback in the form of teaching faculty-facilitated discussion and emailed grades enhanced adult learning with a steady improvement in performance over PGY. Although residents improved with PGY, the data suggest that further improvement in all categories is possible. Implementing this standardized critique algorithm across PGY allows for evaluation of areas of individual resident weakness vs. strength, progression over time, and comparisons to peers. These data suggest that routine complication reporting may be enhanced as a critical thinking assessment tool and that improvement in critical thinking can be quantified. Incorporation of this platform into M&M conference has the potential to augment executive function and professional identity development.

Daily worry, rumination, and sleep in late life.

OBJECTIVE: Perseverative thinking (e.g., worry/rumination) is a common response to stress, and can be detrimental to well-being. Sleep may represent an important mechanism by which perseverative thinking is disrupted or amplified from day to day. This study examined the associations between older adults' everyday worry, rumination, and sleep. METHODS: Older adults (N = 270) aged 65-89 completed a baseline interview and morning and evening assessments each day for 5-6 days. Every morning, they indicated their worry toward the day and their sleep duration and disturbances the prior night. Every evening, they rated worry and rumination experienced that day. RESULTS: Multilevel models showed that perseverative thinking predicted worse sleep (i.e., fewer hours of sleep) at the between-person level (B = -0.29, p = .004) but better sleep (i.e., fewer sleep disturbances) at the within-person level (Bs < -0.18, ps < .003). At the within-person level, more hours of sleep (B = -0.06, p = .04) and fewer sleep disturbances (B = 0.10, p < .001) predicted less worry the next morning. Prior night's worry predicted greater next morning's worry, but this association was significant only when older adults reported fewer-than-usual hours of sleep (B = 0.24, p < .001), not when they reported more-than-usual hours of sleep (B = 0.04, p = .61). CONCLUSION: Findings suggest that worry and rumination are intimately linked with sleep and highlight the protective role that better sleep may play in reducing older adults' everyday perseverative thinking.

Development and validation of a delirium care critical-thinking scale for intensive care unit nurses: A mixed-method study.

AIM AND OBJECTIVES: To develop a Delirium Care Critical-Thinking Scale for nurses caring for patients in the intensive care unit and examine the scale's psychometric properties. BACKGROUND: There is a tool to evaluate nurses' critical thinking skills to determine nursing competency when delirium care is required. DESIGN: This cross-sectional, mixed-methods study. METHODS: The Delphi method was applied for collection and analysis of data during conceptualization and item generation of the tool (Phase I). Item analysis, assessment of validity and reliability of the scale (Phase II) involved 318 nurses recruited by convenience sampling from nine adult intensive care units in medicine and surgery at one medical centre. Confirmatory factor analysis assessed construct validity. Internal consistency and 2-week test-retest stability measured reliability. A Critical Thinking Disposition Inventory Scale examined concurrent validity. RESULTS: After three rounds, the Delphi method resulted in 31 scale items. Item analysis demonstrated construct reliability ranged from 9.23 to 16.18. Confirmatory factor analysis eliminated one item and extracted five factors: applying knowledge, confirming the problem and accuracy of information, reasoning logically, choosing appropriate strategies and remaining open-minded. Average variance extracted values of all factors indicated good convergent validity. Cronbach's α for internal consistency was .96 with good test-retest reliability. The correlation coefficient for concurrent validity was .301. CONCLUSION: The new Delirium Care Critical-Thinking Scale for intensive care nurses was demonstrated to be a reliable and valid tool for evaluating their ability to assess patients with delirium. RELEVANCE TO CLINICAL PRACTICE: This new scale could be used to assess outcomes of education interventions and the effectiveness of nursing care quality involving patients with delirium in intensive and critical care units. REPORTING METHOD: The COSMIN checklist was used as the reporting guideline for this study. PATIENT OR PUBLIC CONTRIBUTION: None.

Effects of episodic future thinking in health behaviors for weight loss: A systematic review and meta-analysis.

BACKGROUND: Obesity and related diseases have become one of the leading causes of death worldwide, which has been linked to biopsychosocial effects such as type 2 diabetes, cardiovascular disease, various cancers, depression, and weight stigma. Episodic future thinking (EFT) has been found to support the development of changes in health behaviors. However, the effectiveness of EFT in enhancing weight loss behavior and health outcomes is not well supported. OBJECTIVE: To establish implementation options for the EFT intervention, and critically synthesize the data that assesses the impact of EFT on weight loss behavior and health outcomes. METHODS: Searches were performed across 5 Chinese and 9 English databases systematically from inception to March 2023. Randomized controlled trials, written in English or Chinese were included. Two independent reviewers evaluated all relevant studies, who also assessed the risk of bias, and extracted the data. Meta-analyses were conducted using Review Manager 5.4.1. The quantity of evidence's certainty was assessed using the Risk bias assessment tool RoB2 (revised version 2019). This study was registered in PROSPERO. RESULTS: A total of 1740 participants were included, and 18 studies were eligible for inclusion. Meta-analysis reported a statistically significant effect size favoring EFT on delay discounting (AUC) (MD = 0.1, 95 % CI: [0.02, 0.17], P = 0.01; I2 = 73 %), delay discounting (K) (MD = -0.85, 95 % CI: [-1.44, -0.26], P = 0.005; I2 = 77 %), energy intake (MD = -107.59, 95 % CI: [-192.21, -22.97], P = 0.01; I2 = 57 %), grocery purchased (SMD: -0.91, 95 % CI:[-1.48, -0.34], P = 0.002; I2 = 63 %), and BMI (MD = -2.73, 95 % CI: [-5.13, -0.32], P = 0.03; I2 = 0 %, two studies). CONCLUSIONS: EFT was found to have favorable effects on delay discounting, energy intake, grocery purchased, and BMI of individuals. The presence of high heterogeneity is evident in most of the outcomes. The modalities of EFT intervention are still in the exploratory phase, there is no consensus on the valence, context type, longest delay time, and practice strategy, and it needs to be further explored for different populations. It is anticipated that additional well-designed studies will continue developing high-quality evidence in this field.

Onde está o sujeito? Reflexões sobre o materialismo e a dialética / Where's the subject? Reflections on materialism and dialectics / ¿Dónde está el sujeto? Reflexiones sobre el materialismo y la dialéctica

Buscamos uma análise acerca dos desdobramentos da questão do sujeito à luz das diversas críticas que a ela se levantaram nos anos pós-estruturalistas e diante da ascensão do neoliberalismo como ideologia dominante em todo o mundo. Relegada como questão metafísica da modernidade, ou como resíduo do cientificismo positivista, a categoria de sujeito tem sido notadamente objeto de desconstrução, ou, quando não, de simples rejeição. Se apoiando sobre um duplo questionamento, de sua possível pertinência para o pensamento psicológico e filosófico atual, como dos possíveis atores da transformação social diante das transformações sofridas que o capitalismo tardio impõe à categoria de proletariado, através do pensamento de Alain Badiou e Slavoj Zizek, tentamos afastar a tendência linguística que hoje pauta grande parte das análises sobre o sujeito e os processos subjetivos para tentar apontar a importância de uma teoria das verdades que renove as bases ontológicas do pensamento e a visão sobre a dialética materialista. Uma teoria do sujeito assentada sobre um conceito de verdade se mostra assim um potencial para repensar o homem enquanto criador. (AU)

We seek an analysis of the developments surrounding the issue of the subject in light of various critiques that have emerged in the post-structuralist years and in the face of the rise of neoliberalism as the dominant ideology worl-dwide. Relegated as a metaphysical question of modernity or as a residue of positivist scientism, the category of the subject has notably been a target of deconstruction, or, when not, outright rejection. Grounded in a dual inquiry into its possible relevance for current psychological and philosophical thought, as well as the potential actors of social transformation in the face of the changes imposed by late capitalism on the proletariat category, through the prospectives of Alain Badiou and Slavoj Zizek, we attempt to move away from the linguistic trend that currently guides a significant portion of analyses on the subject and subjective processes. Our aim is to emphasize the importance of a theory of truths that renews the ontological foundations of thought and the perspective on dialectical materialism. A theory of the subject anchored in a concept of truth thus proves to be a potential avenue for rethinking man as a creator. (AU)

Buscamos un análisis del desarrollo del tema del sujeto a la luz de las diversas críticas que surgieron en los años postestructuralistas y ante el surgimiento del neoliberalismo como ideología dominante a nivel mundial. Relegada como cuestión metafísica de la modernidad, o como residuo del cientificismo positi-vista, la categoría de sujeto ha sido notablemente objeto de deconstrucción o, cuando no, de simple rechazo. Partiendo de un doble cuestionamiento, de su posible relevancia para el pensamiento psicológico y filosófico actual, como de los posibles actores de la transformación social frente a las transforma-ciones que el capitalismo tardío impone a la categoría de proletariado, a través del pensamiento de Alain Badiou y Slavoj Zizek , intentamos quitar la tendencia lingüística que hoy guía la mayoría de los análisis sobre el tema y los procesos subjetivos para intentar señalar la importancia de una teoría de las verdades que renueve las bases ontológicas del pensamiento y la mirada sobre la dialéctica materialista. Una teoría del sujeto basada en un concepto de verdad muestra así un potencial para repensar al hombre como creador. (AU)

Assessing the effectiveness of a digital, case-based learning platform for cancer pain management in residency training.

Objectives: To determine the effectiveness of self-directed, case-based learning in cancer pain management via a digital learning platform (e-CBL) in interdisciplinary residents' knowledge and critical thinking skill level. Methods: The prospective observational study was conducted on 51 first- and second-year residents from anesthesiology, surgery, and family medicine who had not received training in the management of cancer pain and were invited to participate by their Program Director. Participants voluntarily underwent e-CBL in cancer pain management using four modules (pain assessment, principles of pain management, pharmacological techniques, and non-pharmacological techniques) at their convenience within seven days via the Moodle platform. All participants underwent pre-and post-test assessments of knowledge and rated their satisfaction with the training on a 0-10 scale. Thirty-two residents completed Cornell Critical Thinking Test Level Z. Paired t-tests assessed changes, and the effect size was estimated by Cohen's d. A p-value < .05 was considered statistically significant. Results: Knowledge and critical thinking test results significantly improved after the training (M=68, SD=16.99 to M=86, SD=13.96 correct responses; t(50)=11.24, p<.001, Cohen's d=1.56 for knowledge) and (M=39.8, SD=13.7 vs. M=46.1, SD=10.2 correct responses; t(31)=-3.67, p=.001, Cohen's d=0.65 for critical thinking test). Satisfaction of learning experiences for convenience and understandability was high (M=9.4, SD=0.8). Conclusions: Use of the e-CBL improved knowledge in cancer pain management and critical thinking skills. This digital platform could play an important role in the future of pain education. Further investigation, including a control group, is warranted.

Sesgos cognitivos en el dolor crónico no oncológico / Cognitive biases in chronic non-cancer pain

Los sesgos cognitivos son un constructo que acuñaron Kahneman & Tveysky (1972) en su Enfoque de Sesgos dentro de la Psicología Cognitiva. Estos son atajos intelectuales que realizan siempre las personas, desde un razonamiento probabilístico intuitivo. El presente trabajo es una primera aproximación que intenta aplicar y describir algunos sesgos cognitivos en el complejo mundo de las representaciones mentales en la experiencia dolorosa, como la ilusión de control; del presente; la confirmación; representatividad; disponibilidad, entre otros. Los sesgos en dolor nos permiten comprender el procesamiento de información frente al dolor y utilizar estrategias comunicacionales más efectivas para su abordaje.

Cognitive biases are a construct coined by Kahneman & Tveysky (1972) in their Approach to Biases in Cognitive Psychology. These are intellectual shortcuts that people always carry out, from an intuitive probabilistic reasoning. An attempt is made to apply and describe some cognitive biases in the complex world of mental representations in the painful experience, like the illusion of control; of the present; the confirmation; representativeness; availability among others. Biases in pain allow us to understand the processing of information in the face of pain and use more effective communication strategies to address it.

Narratives in the Journal of Medical Imaging and Radiation Sciences: Publishing stories in an academic journal.

Healthcare narratives can be used for education to elicit an emotional or affective response, develop critical thinking, and gain perspective on individuals' experiences with life and illness to cultivate person-centered care. This editorial describes the recent experience of the Journal of Medical Imaging and Radiation Sciences (JMIRS) in developing a new narrative submission format. The processes of engaging and supporting patient authors as well as creating a more accessible submission and review process are presented. Finally, the paper discusses the emerging impact of published narratives and the benefit of working with patients as experts and authors.

Twisted memories: Addiction-related engrams are strengthened by desire thinking.

Associative learning plays a central role in addiction by reinforcing associations between environmental cues and addiction-related information. Unsupervised learning models posit that memories are adjusted based on how strongly these representations are coactivated during the retrieval process. From a different perspective, clinical models of addiction posit that the escalation and persistence of craving may depend on desire thinking, a thinking style orienting to prefigure information about positive addiction-related experiences. In the present work, we tested the main hypothesis that desire thinking is a key factor in the strengthening of addiction-related associations. A group of adult smoking volunteers (N = 26) engaged in a period of desire thinking before performing an associative learning task in which neutral words (cues) were shown along with images (smoking-related vs. neutral context) at different frequencies. Two retrieval tests were administered, one immediately after encoding and the other after 24 h, to test how the recall of associations changed as a function of retention interval. Two control groups, smokers (N = 21) and non-smokers (N = 22), performed a similar procedure, with a neutral imagination task replacing desire thinking. Participants who engaged in desire thinking increased their performance from the first to the second retrieval test only for the most frequent smoking-related associations. Crucially, this selective effect was not observed in the two control groups. These results provide behavioral evidence in support of the idea that desire thinking plays a role in strengthening addiction-related associations. Thus, this thinking process may be considered a target for reconsolidation-based conceptualizations of, and treatments for, addiction.

Epistemología de la investigación social / Epistemology of social research

INTRODUCCIÓN. La epistemología, rama de la filosofía que estudia el proceso de investigación y su producto el conocimiento científico, implica ámbitos de la ciencia con enfoque positivismo y postpositivismo, interpretativismo, teoría crítica; y, transcomplejo, cada uno de ellos con los elementos paradigmáticos de: ontología, epistemología y metodología, su conocimiento y aplicabilidad en los diferentes ámbitos es fundamental porque sus enfoques generan ciencia. OBJETIVO. Desarrollar capacidades intelectuales en bases contextuales y teóricas en epistemología de la investigación social, indispensables para el ejercicio profesional en el ámbito de la investigación científica y del conocimiento científico. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, con población y muestra conocida de 30 modalidades de publicación, periodo junio a julio 2020. Los criterios de inclusión fueron: fuentes secundarias de información bibliográfica validadas en el ámbito de las ciencias sociales. La técnica de observación fue en buscadores bibliográficos PUBMED, Scielo, Scopus, Diccionario de Descriptores en Ciencias de la Salud y la Real Academia Española. La tarea de revisar la literatura de investigación comprendió la identificación, selección, análisis crítico, descripción escrita, interpretación, discusión y conclusión de la información que existe sobre la epistemología de la investigación social, tema, que se registró con aplicación de un gestor de referencias bibliográficas, tipo Microsoft Word. RESULTADOS. Se logró obtener capacidades intelectuales al estructurar la cronológica de la epistemología de la investigación social, del conocimiento científico y nuevas perspectivas para el ejercicio profesional en el ámbito de la investigación científica. CONCLUSIÓN. Las perspectivas se orientan a integrar paradigmas pasados y futuros con visión de transcomplejidad, espacios organológicos de una gran red, conformación de cibercomunidades de investigación, uso de método integrador, nuevo lenguaje en equipos multidisciplinarios, agentes como el foco principal de la teoridad epistémica en espacio, tiempo y la relación entre las cosas.

INTRODUCTION. Epistemology, a branch of philosophy that studies the research process and its product, scientific knowledge, involves areas of science focussed in with positivism and postpositivism, interpretivism, critical theory; and, transcomplex, each one of them with the paradigmatic elements of: ontology, epistemology and methodology, their knowledge and applicability in the different fields is fundamental because their approaches generate science. OBJECTIVE. Develop intellectual capacities on contextual and theoretical bases in the epistemology of social research, essential for professional practice in the field of scientific research and scientific knowledge. MATERIALS AND METHODS. Observational, descriptive study, with population and a known sample of 30 publication modalities, period June to July 2020. The inclusion criteria were: secondary sources of bibliographic information validated in the field of social sciences. The observation technique was in bibliographic search engines PUBMED, Scielo, Scopus, Dictionary of Descriptors in Health Sciences and the Royal Spanish Academy. The task of reviewing the research literature included the identification, selection, critical analysis, written description, interpretation, discussion and conclusion of the information that exists on the epistemology of social research, subject, which was registered with the application of a reference manager bibliographic, Microsoft Word type. RESULTS. Intellectual capacities were obtained by structuring the chronology of the epistemology of social research, scientific knowledge and new perspectives for professional practice in the field of scientific research. CONCLUSION. The perspectives are aimed at integrating past and future paradigms with a vision of transcomplexity, organological spaces of a large network, formation of research cyber communities, use of integrative method, new language in multidisciplinary teams, agents as the main focus of epistemic theory in space, time and the relationship between things.

Investigating divergent thinking and creative ability in surgeons (IDEAS): a survey protocol.

INTRODUCTION: A strong pipeline of creative ideas and individuals is critical if we are to tackle the complex healthcare challenges we will face in the 21st century. The field of creativity is severely underinvestigated in the context of surgery, and it is of interest to explore the level and nature of creativity in surgeons, across various specialties and backgrounds. Identifying the areas of surgery with strong and weak levels of creativity, as well as the predictors of high creativity among surgeons, may aid in the selection and training of future surgeons. METHODS AND ANALYSIS: A convenience sample of surgeons from the Department of Surgery and McMaster University will be used for the recruitment of participants. The Abbreviated Torrance Test for Adults, a three-part test of divergent thinking ability, will be administered to measure the level and nature of creativity among surgeons. Descriptive analyses and multiple linear regression models are planned to synthesise the results of the survey and identify predictors of divergent thinking ability among surgeons. ETHICS AND DISSEMINATION: Ethics approval from the Hamilton Integrated Research Ethics Board was obtained. No harm is expected due to participation in this study. The results of this survey will be published in a peer-reviewed journal and disseminated through conferences and presentations at the regional, national and international levels.

Estratégias de ensino para desenvolvimento do pensamento crítico na graduação em enfermagem: overview de revisões sistemáticas / Educational strategies for development of clinical reasoning and critical thinking in nursing undergraduate students: overview protocol of systematic reviews

Resumo: O objetivo desta pesquisa foi sumarizar as evidências de revisões sistemáticas sobre a efetividade das estratégias de ensino para o desenvolvimento do raciocínio clínico ou pensamento crítico em estudantes da graduação em Enfermagem. Trata-se de uma overview de revisões sistemáticas, guiada pelas recomendações do Cochrane Handbook. O protocolo de pesquisa foi registrado na plataforma Prospero sob o número 187785, sendo este estudo inédito. O uso do protocolo possibilita a replicação ou atualização dessa overview. A pergunta de pesquisa foi: Quais as evidências de efetividade oriundas de revisões sistemáticas sobre as estratégias de ensino, isoladas, comparadas ou associadas, para o desenvolvimento do pensamento crítico dos estudantes de graduação em Enfermagem, em qualquer ambiente de aprendizagem? A busca por revisões Cochrane e não Cochrane foi realizada em oito bases de dados e bibliotecas, e na literatura cinzenta. Não houve restrições de idioma e ano de publicação. Foi recuperado um total de 13.936 estudos, com 6.620 participantes. Dois revisores independentes aplicaram os critérios de inclusão e exclusão, fizeram a extração dos dados e a análise de qualidade das revisões. Foram incluídas 11 revisões, com 65 estudos primários. As sínteses foram descritivas e por metanálises. A análise do risco de viés das revisões sistemáticas foi realizada por meio do instrumento ROBIS (Risk of Bias in Systematic Reviews); a qualidade metodológica foi avaliada pelo instrumento AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews); e a análise da força da evidência seguiu as recomendações do sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation). Quatorze estudos, com 1.350 participantes, forneceram evidências para metanálise. As evidências, ainda que classificadas como de certeza muito baixa, sugerem que a aprendizagem baseada em problemas e a simulação são estratégias de ensino que possibilitam o desenvolvimento do pensamento crítico em estudantes de graduação em enfermagem. Risco de viés, heterogeneidade elevada, número limitado de estudos, número de participantes reduzido contribuíram para o rebaixamento do nível de certeza das evidências. Recomenda-se que os docentes avaliem as características dos estudantes antes de optarem por uma ou outra estratégia de ensino, e ponderem o uso diversificado. São importantes a frequência e duração da aplicação das estratégias, uma vez que o desenvolvimento do pensamento crítico ocorre de forma processual e contínua. Recomenda-se aos pesquisadores que o relato seja aprimorado, incluindo informações relevantes, como dados estatísticos, características do estudante e do ambiente de ensino. O uso de ferramentas que orientem um relato de qualidade é indicado. No planejamento dos ensaios clínicos, é relevante prever e padronizar o tempo de exposição à estratégia de ensino e a quantidade de sessões; utilizar pelo menos duas escalas de mensuração do pensamento crítico e aplicá-las no mínimo antes e após a intervenção. Tais cuidados promovem robustez aos resultados. A contribuição social dessa tese inédita é a identificação de estratégias de ensino - aprendizagem baseada em problemas e simulação - eficazes para o desenvolvimento do pensamento crítico em estudantes de enfermagem, o que possibilita, consequentemente, aprimorar a qualificação dos futuros enfermeiros para a prática profissional segura e baseada em evidências.

Abstract: The aim of this study was to summarize evidence from systematic reviews on the effectiveness of teaching strategies for the development of clinical reasoning or critical thinking in undergraduate nursing students. This is an overview of systematic reviews guided by the Cochrane Handbook recommendations. The research protocol was registered on the Prospero platform under number 187785 and this study is unprecedented. The use of the protocol makes it possible to replicate or update this overview. The research question was: What is the evidence of effectiveness from systematic reviews on teaching strategies, isolated, compared or associated, for the development of critical thinking of undergraduate nursing students in any learning environment? The search for Cochrane and non-Cochrane reviews was performed in eight databases and libraries, and in the gray literature. There were no language and year of publication restrictions. A total of 13,936 studies with 6,620 participants were retrieved. Two independent reviewers applied inclusion and exclusion criteria and performed data extraction and quality analysis of the reviews. Eleven reviews with 65 primary studies were included. The syntheses were descriptive and by meta-analyses. Analysis of the risk of bias of systematic reviews was performed using the ROBIS instrument (Risk of Bias in Systematic Reviews); methodological quality was assessed using the AMSTAR 2 instrument (A MeaSurement Tool to Assess Systematic Reviews); and analysis of the strength of evidence followed the recommendations of the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). Fourteen studies of 1,350 participants provided evidence for meta-analysis. Despite the very low certainty of the evidence, findings suggest that the teaching strategies of problem-based learning and simulation enable the development of critical thinking in undergraduate nursing students. Risk of bias, high heterogeneity, limited number of studies, and reduced number of participants contributed to lower the level of certainty of the evidence. It is recommended that professors assess students' characteristics before choosing one or another teaching strategy and consider diversified use. The frequency and duration of the application of strategies is important, since the development of critical thinking occurs in a procedural and continuous way. It is recommended that researchers improve the report, including relevant information such as statistical data and characteristics of students and the teaching environment. The use of tools that guide a quality report is indicated. When planning clinical trials, it is important to predict and standardize the time of exposure to the teaching strategy and the number of sessions; use at least two clinical reasoning measurement scales and apply them at least before and after the intervention. These precautions bring robustness to the results. The social contribution of this unpublished thesis is the identification of effective teaching strategies for the development of critical thinking in nursing students, problem-based learning and simulation, thereby making it possible to improve the qualification of future nurses for a safe and evidence-based professional practice.

Filosofia e processo de enfermagem: uma reflexão das bases teórico filosóficas / Na prática clínica de enfermagem philosophy in the nursing process: an reflection of theoretical philosophical bases in the clinical nursing practice / Filosofía en el proceso de enfermería: una reflexión de las bases teórico filosóficas na práctica clínica de enfermería

Objetivo: refletir sobre a aproximação e influência de pressupostos filosóficos na aplicação do processo de enfermagem na prática clínica. Métodos: trata-se de uma reflexão teórico crítica, para a qual serviram de base produções científicas sobre Filosofia e processo de enfermagem publicadas em periódicos nacionais e internacionais. Resultados: a partir da análise das produções científicas identificou-se as contribuições dos pressupostos filosóficos e do pensamento crítico para a qualidade do processo de Enfermagem; e a aplicação prática da filosofia no processo de enfermagem e desafios a serem enfrentados. Conclusão: os pressupostos filosóficos alicerçam as práticas em enfermagem e saúde denotando a qualidade e a sensibilidade necessárias nos cuidados de enfermagem prestados aos indivíduos. o pensamento filosófico é um dos caminhos que possibilita a compreensão da totalidade das diferentes realidades concretas e que no processo de enfermagem traz reflexões importantes para a qualidade do cuidado prestado aos usuários dos diferentes serviços de saúde. (AU)

Objective: reflect on the approach and influence of philosophical assumptions in the application of the nursing process in clinical practice. Methods: it is an article of theoretical reflection, for which scientific productions on Philosophy and nursing process published in national and international journals were used as basis. Results: from the analysis of scientific productions, the contributions of philosophical assumptions and critical thinking to the quality of the nursing process were identified; and the practical application of philosophy in the nursing process and challenges to be faced. Conclusion: the philosophical assumptions underpin nursing and health practices, denoting the necessary quality and sensitivity in caring of nursing for individuals. philosophical thinking is one of the ways that enables the comprehension of all the different concrete realities and that in the nursing process brings important reflections for the quality of care provided to users of different health services. (AU)

Objetivo: reflexionar sobre el abordaje e influencia de los supuestos filosóficos en la aplicación del proceso de enfermería en la práctica clínica. Métodos: se trata de un artículo de reflexión teórica, para lo cual se basaron las producciones científicas sobre Filosofía y procesos de enfermería publicados en revistas nacionales e internacionales. Resultados: a partir del análisis de las producciones científicas, se identificaron los aportes de los supuestos filosóficos y el pensamiento crítico a la calidad del proceso de enfermería; y la aplicación práctica de la filosofía en el proceso de enfermería y desafíos a enfrentar. Conclusion: los supuestos filosóficos sustentan las prácticas de enfermería y salud, denotando la calidad y sensibilidad necesarias en el cuidado de enfermería prestado a las personas. El pensamiento filosófico es una de las vías que posibilita la comprensión de todas las diferentes realidades concretas y que en el proceso de enfermería trae importantes reflexiones sobre la calidad de la atención brindada a los usuarios de los diferentes servicios de salud. (AU)