Critical Thinking and Nurses' Caring Behavior in Clinical Practice: A Cross-sectional Study
A Cross-Sectional Study
Abstract
Background: Caring behavior is essential in nursing professionalism and is linked to the quality of nursing care. Nurses are responsible for providing holistic, patient-centered healthcare that includes various dimensions of well-being. However, nursing practice often lacks a holistic approach, especially as patient cases become more complex. Balancing critical thinking skills with caring behavior is crucial to meet the demands of nursing practice.
Objective: To examine the association between critical thinking skills and caring behavior among ward inpatient nurses at Perkebunan Jember Klinik Hospital.
Methods: A cross-sectional correlational study was conducted among all 82 nurses in tbe inpatient ward through total sampling. Critical thinking ability were measured using a NCT-4 Practice, and Caring behavior were assessed using Caring Behavior Questionnaire. Descriptive statistics were calculated for participant characteristics and study variables. The association between critical thinking skills and caring behavior was tested using Kendall’s Tau C (a =0,05).
Results: Participants had a median age of 35 years and the work experience of nurses 10,5 years, were most female (76,8%), with the nurses’ highest education is in the nursing profession (72%) and the majority nurses are married (93,9%). The majority partisipants also attended the training (91,5%). Kendall’s Tau C indicated a statistically significant, weak correlation between critical thinking skills and caring behavior, with moderate critical thinking skills tending to be associated (|τ| = 0,376, p = 0,000), with caring conduct that is nonetheless considered to be deficient
Conclusion: Critical thinking skills were significantly correlation with caring behavior among ward inpatient nurses.The development of evidence-based practice and the enhancement of clinical reasoning capacity through training and independent literature exploration are recommended to improve daily clinical critical thinking skills.
References
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Swanson, K. M. (1991). Empirical development of a middle-range theory of caring. Nursing Research, 40(3), 161-165.
Tong, L. K., Au, M. L., Li, Y. Y., Ng, W. I., & Wang, S. C. (2023). The mediating effect of critical thinking between interest in learning and caring among nursing students: a cross-sectional study. BMC nursing, 22(1), 30. https://doi.org/10.1186/s12912-023-01181-4
Urhan, E., Zuriguel‐Perez, E., & Harmancı Seren, A. K. (2022). Critical thinking among clinical nurses and related factors: A survey study in public hospitals. Journal of Clinical Nursing, 31(21-22), 3155-3164. https://doi.org/10.1111/jocn.16141
Van Nguyen, T., & Liu, H. E. (2021). Factors associated with the critical thinking ability of professional nurses: A cross‐sectional study. Nursing Open, 8(4), 1970-1980. https://doi.org/10.1002/nop2.875
Vujanic, J., Prlic, N., & Lovric, R. (2020). Nurses’ self-assessment of caring behaviors in nurse-patient interactions: A cross-sectional study. International Journal of Environmental Research and Public Health, 17, 5255. https://doi.org/10.3390/ijerph17145255
Yusiyanto, W., & Mevia, M. A. (2023). Studi Deskriptif Kepatuhan Penggunaan Alat Pelindung Diri Pada Perawat Di Ruang Rawat Inap Cempaka 2 Dan Sakura Di Rsud Kayen Pati Tahun 2023. Jurnal Profesi Keperawatan, 10(2), 198-206.
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Zuriguel-Pérez, E., Falcó-Pegueroles, A., Agustino-Rodríguez, S., del Carmen Gómez-Martín, M., Roldán-Merino, J., & Lluch-Canut, M. T. (2019). Clinical nurses's critical thinking level according to sociodemographic and professional variables (phase II): a correlational study. Nurse education in practice, 41, 102649. https://doi.org/10.1016/j.nepr.2019.10264
Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., McHugh, M. D., & US Clinician Wellbeing Study Consortium (2023). Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover, Outcomes, and Patient Safety. JAMA health forum, 4(7), e231809. https://doi.org/10.1001/jamahealthforum.2023.1809
Aldhafeeri, H. O. F., SHMMAR, J. A. A., salm bneah AlFadan, A., Aldhafeeri, E. A. D., Aldhafeeri, M. O., & Alanazy, F. E. (2024). The impact of gender dynamics on professional development and practice among nurses in Saudi Arabian hospitals: a review. Journal of International Crisis and Risk Communication Research, 7(S11), 2379. https://doi.org/10.63278/jicrcr.vi.1640
Alfaro-LeFevre, R. (2016). Critical thinking, clinical reasoning and clinical judgment 6th edition: A practical approach, pageburst E-book on kno. Elsevier Health Sciences.
Alfaro-LeFevre, R (2019). Critical thinking, clinical reasoning and clinical judgment 7th edition: A practical approach, pageburst E-book on kno. Elsevier Health Sciences.
American Nurses' Association. (2023). Scope and standards of advanced practice registered nursing. Retrieved from https://www.nursingworld.org/practice-policy/aprn/
Aziz, A. (2023). The Effect of Career Development and Job Satisfaction on Nurses' Caring Behavior in Patients in Inpatient Hospital X Karawang in 2023. Jurnal Syntax Transformation. 4(11). 84-96. https://doi.org/10.46799/jst.v4i11.853.
Bachtiar, A., Utomo, A. S., & Septyasih, R. (2023). Prevalence of the poor caring behavior among Indonesian nurses: a systematic review and meta-analysis. International Journal of Caring Sciences, 16(2), 880-890.
Baduge, M. S. D. S. P., Garth, B., Boyd, L., Ward, K., Joseph, K., Proimos, J., & Teede, H. J. (2024). Barriers to advancing women nurses in healthcare leadership: a systematic review and meta-synthesis. EClinicalMedicine, 67. https://doi.org/10.1016/j.eclinm.2023.102354
Christie, V., Amin, J., Skinner, J., Green, D., Littlejohn, K., & Gwynne, K. (2022). Comparison of study quality as determined by standard research and community engagement metrics: A pilot study on breast cancer research in urban, rural, and remote indigenous communities. International Journal of Environmental Research and Public Health, 19(9). 5008. https://doi.org/10.3390/ijerph19095008
Devi, K., Hananingrum, P., & Wahyudiono, Y. (2023). Why Does Work Stress Occur in Nurses?. The Indonesian Journal of Occupational Safety and Health. https://doi.org/10.20473/ijosh.v12i1.2023.95-103.
Elhabashy, S., Moriyama, M., Mahmoud, E. I. E. D., & Eysa, B. (2024). Effect of evidence-based nursing practices training programme on the competency of nurses caring for mechanically ventilated patients: a randomised controlled trial. BMC nursing, 23(1), 225. https://doi.org/10.1186/s12912-024-01869-1
Facione, P. A. (1990). Critical thinking: A statement of expert consensus for purposes of educational assessment and instruction (The Delphi Report).
Facione, P Critical thinkin: What it is and why it counts. (2010 update). Retrieved from http://www.insightassesment.com/pdf_files/what&why2007.pdf.
Ferede, A. J., Gezie, L. D., Geda, B., Salih, M. H., Erlandsson, K., & Wettergren, L. (2024). Nurses’ perceptions of caring behaviors at referral hospitals in Ethiopia: A mixed-methods approach. BMC nursing, 23(1), 767. https://doi.org/10.1186/s12912-024-02431-9
Goudarzian, A., Nasrabadi, A., Sharif-Nia, H., Farhadi, B., & Navab, E. (2024). Exploring the concept and management strategies of caring stress among clinical nurses: a scoping review. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1337938.
Harahap, S. Y., Banjarnahor, S., & Simatupang, L. L. (2025). Persepsi Pasien Terkait Penerapan Caring Perawat Di Ruang Rawat Jalan Dan Rawat Inap. Excellent Midwifery Journal, 8(1), 384-397.
Hasan, A., & Noor, H. (2024). Correlation between emotional intelligence and critical thinking disposition among undergraduate Saudi nursing students. SAGE open nursing, 10, https://doi.org/10.1177/23779608241296069
Hidayat, M., Muharni, S., & Wardhani, U. (2023). Nurse Caring Behavior Experienced Patients Based on Swanson's Theory in The Inpatient Room of X Hospital Batam. Indonesian Health Journal. https://doi.org/10.58344/ihj.v2i2.71.
Howle, A., Carter, G., & Reising, D. (2025). Contemporary factors influencing professional identity in acute care nurses: an integrative review. Journal of Advanced Nursing, 81(10), 6134-6154. https://doi.org/10.1111/jan.16755
Jiang, J., Du, J., Sun, Y., Zhang, P., Gong, Y., Sun, Y., & Qu, H. (2025). The mediating role of empathy and moral sensitivity in nurses' spiritual health and spiritual caregiving competence: a cross-sectional study. BMC nursing, 24(1), 646. https://doi.org/10.1186/s12912-025-03274-8
Kharazmi, E., Bordbar, N., & Bordbar, S. (2023). Distribution of nursing workforce in the world using Gini coefficient. BMC nursing, 22(1), 151. https://doi.org/10.1186/s12912-023-01313-w
Kibret, H., Tadesse, B., Debella, A., Degefa, M., & Regassa, L. D. (2022). Level and predictors of nurse caring behaviors among nurses serving in inpatient departments in public hospitals in Harari region, eastern Ethiopia. BMC nursing, 21(1), 76. https://doi.org/10.1186/s12912-022-00856-8
Krone-Hjertstrøm, H., Norbye, B., Abelsen, B., & Obstfelder, A. (2025). If not us, then who? Ethnographic insights into nurses’ role in redesigning a rural health service to meet changing demands. BMC Health Services Research, 25. https://doi.org/10.1186/s12913-025-12397-2.
Kusmiran, E. (2015). Soft skills caring dalam pelayanan keperawatan. Jakarta: Trans Info Media.
Labrague, Leodoro J., Janet Alexis A. De los Santos, Konstantinos Tsaras, Jolo R. Galabay, Charlie C. Falguera, Rheajane A. Rosales, and Carmen N. Firmo. (2020). The Association of Nurse Caring Behaviours on Missed Nursing Care, Adverse Patient Events and Perceived Quality of Care: A Cross‐sectional Study. Journal of Nursing, 28(8), 2257-2265. https://doi.org/10.1111/jonm.12894
Martínez-Momblan, M. A., Aguilar, I. B., Alonso-Fernández, S., García, M. R., Zuriguel-Pérez, E., Falcó-Pegueroles, A., & Aracil, L. B. (2023). Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: A multicenter correlation study. Nurse education in practice, 71, 103713. https://doi.org/10.1016/j.nepr.2023.103713
Melikoğlu, S. E., Dalcalı, B. K., & Demir, B. D. (2024). The Relationship between Nursing Students’ Attitudes Toward Evidence-Based Nursing and Their Critical Thinking Dispositions. Journal of Education & Research in Nursing/Hemşirelikte Eğitim ve Araştırma Dergisi, 21(1). https://doi.org/10.14744/jern.2023.52223
Meneses-La-Riva, M., Fernández-Bedoya, V., Suyo-Vega, J., Ocupa-Cabrera, H., Grijalva-Salazar, R., & Di Deus Ocupa-Meneses, G. (2025). Enhancing Healthcare Efficiency: The Relationship Between Effective Communication and Teamwork Among Nurses in Peru. Nursing Reports, 15. https://doi.org/10.3390/nursrep15020059.
Nurfitriani, S., Hamidah, E., & Abdillah, H. (2025). Hubungan Komunikasi Terapeutik Perawat dengan Kepuasan Pasien di Rawat Inap. Malahayati Nursing Journal. https://doi.org/10.33024/mnj.v7i4.19033.
Ominyi, J., Eze, U., Agom, D., Alabi, A., & Nwedu, A. (2025). Implementing Evidence-Based Practice In Critical Care Nursing: An Ethnographic Case Study of Knowledge Use. Journal of Advanced Nursing, 82, 2407-2426. https://doi.org/10.1111/jan.70054.
Randall, S., Jones, D. M., Hadaddan, G., White, D., & Einboden, R. (2024). It's all about relationships: Developing nurse‐led primary health care in rural communities. Nursing Inquiry, 31(4), e12674.https://doi.org/10.1111/nin.12674
Sampouw, N., Lainsamputty, F., & Bulage, D. (2022). Dimensi berpikir kritis dan perilaku caring pada perawat rumah sakit. Holistik Jurnal Kesehatan. https://doi.org/10.33024/hjk.v16i5.7660.
Schlicht, L., Wendsche, J., Melzer, M., Tschetsche, L., & Rösler, U. (2025). Digital technologies in nursing: an umbrella review. International journal of nursing studies, 161, 104950. https://doi.org/10.1016/j.ijnurstu.2024.104950
Sitio, T., Setiawan, A., & Rusdhiati, F. (2022). Kajian Faktor yang Mempengaruhi Kemampuan Berpikir Kritis Perawat Klinis di Instalasi Rawat Inap. Journal of Telenursing (JOTING). https://doi.org/10.31539/joting.v4i2.3798.
Sumarni, T., Rakhmawati, A. N., & Suhendro, A. (2023). Komitmen Organisasi dan Perilaku Caring Perawat di Ruang Rawat Inap RS Dadi Keluarga. JI-KES (Jurnal Ilmu Kesehatan), 6(2), 194-204.
Swanson, K. M. (1991). Empirical development of a middle-range theory of caring. Nursing Research, 40(3), 161-165.
Tong, L. K., Au, M. L., Li, Y. Y., Ng, W. I., & Wang, S. C. (2023). The mediating effect of critical thinking between interest in learning and caring among nursing students: a cross-sectional study. BMC nursing, 22(1), 30. https://doi.org/10.1186/s12912-023-01181-4
Urhan, E., Zuriguel‐Perez, E., & Harmancı Seren, A. K. (2022). Critical thinking among clinical nurses and related factors: A survey study in public hospitals. Journal of Clinical Nursing, 31(21-22), 3155-3164. https://doi.org/10.1111/jocn.16141
Van Nguyen, T., & Liu, H. E. (2021). Factors associated with the critical thinking ability of professional nurses: A cross‐sectional study. Nursing Open, 8(4), 1970-1980. https://doi.org/10.1002/nop2.875
Vujanic, J., Prlic, N., & Lovric, R. (2020). Nurses’ self-assessment of caring behaviors in nurse-patient interactions: A cross-sectional study. International Journal of Environmental Research and Public Health, 17, 5255. https://doi.org/10.3390/ijerph17145255
Yusiyanto, W., & Mevia, M. A. (2023). Studi Deskriptif Kepatuhan Penggunaan Alat Pelindung Diri Pada Perawat Di Ruang Rawat Inap Cempaka 2 Dan Sakura Di Rsud Kayen Pati Tahun 2023. Jurnal Profesi Keperawatan, 10(2), 198-206.
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), 175. https://doi.org/10.3390/nursrep15050175
Zuriguel‐Pérez, E., Falcó‐Pegueroles, A., Roldán‐Merino, J., Agustino‐Rodriguez, S., Gómez‐Martín, M. D. 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.
Zuriguel-Pérez, E., Falcó-Pegueroles, A., Agustino-Rodríguez, S., del Carmen Gómez-Martín, M., Roldán-Merino, J., & Lluch-Canut, M. T. (2019). Clinical nurses's critical thinking level according to sociodemographic and professional variables (phase II): a correlational study. Nurse education in practice, 41, 102649. https://doi.org/10.1016/j.nepr.2019.10264
Published
2026-05-25
How to Cite
FADHILLA, Ailsa Ayu et al.
Critical Thinking and Nurses' Caring Behavior in Clinical Practice: A Cross-sectional Study.
Journal of Bionursing, [S.l.], v. 8, n. 2, p. 178-192, may 2026.
ISSN 2685-6484.
Available at: <https://jos.unsoed.ac.id/index.php/job/article/view/20635>. Date accessed: 13 june 2026.
doi: https://doi.org/10.20884/1.job.2026.8.2.20635.
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Articles
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Kampus keperawatan unsoed 
Published By Jurusan Keperawatan FIKES UNSOED
bionursing@unsoed.ac.id
