Enhancing critical thinking skills and self-directed learning among critical care nursing students: a quasi-experimental study on the impact of the modified KWHLAQ strategy

Abstract

To evaluate the effect of the modified Know–Want–Learn–How–Apply–Questions (KWHLAQ) strategy on critical thinking and self-directed learning among third-semester undergraduate nursing students enrolled in a critical care nursing course. A quasi-experimental, nonequivalent control group pretest–posttest design was employed. One hundred undergraduate nursing students (n = 50 per group) enrolled in the Critical and Emergency Nursing Department, Faculty of Nursing, Alexandria University, participated during the 2025 academic session. The study group received a 12-week structured intervention based on the KWHLAQ framework; the control group received standard lecture-based instruction. Both groups completed the Critical Thinking Questionnaire (CThQ; α = 0.80) and the Self-Directed Learning Instrument (SDLI; α = 0.80) before and after the intervention. After covariate adjustment, the study group demonstrated significantly higher post-intervention critical thinking scores than the control group (p < 0.05; Cohen’s d = 0.67, moderate-to-large effect). The study group improved significantly in overall critical thinking (mean difference = 5.66; p < 0.01) and in the evaluating subscale (mean difference = 4.50; p < 0.001; Cohen’s d = 2.10, whereas the control group’s scores declined. Self-directed learning improved substantially in the study group (mean difference = 23.06; p < 0.001; Cohen’s d = 2.45), with significant gains across all four SDLI subscales. Integration of this structured, low-cost, and replicable pedagogical framework into nursing curricula may promote active learning, reflective reasoning, and clinical decision-making competencies essential for high-acuity practice.