Original Research

Development of higher-order thinking skills in nursing students through online problem-based assessment

Olivia B. Baloyi
Health SA Gesondheid | Vol 28 | a2423 | DOI: https://doi.org/10.4102/hsag.v28i0.2423 | © 2023 Olivia B. Baloyi | This work is licensed under CC Attribution 4.0
Submitted: 26 April 2023 | Published: 24 October 2023

About the author(s)

Olivia B. Baloyi, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa


Background: The development of higher-order thinking skills (HOTS) in problem-based learning (PBL) is not confined to teaching and learning but extends to authentic assessment methods, similar to real-life situations. The assessments aligned to PBL attempt to eliminate the students’ tendency towards memorisation. Rather, it instils and encourages their ability to analyse, interpret, synthesise, and evaluate knowledge and its sources.

Aim: The study had two primary aims: (1) to describe undergraduate nursing students’ experiences of an online problem-based assessment (PBA), and (2) to explore how online PBA assessment contributed to the development of undergraduate student nurses’ HOTS.

Setting: An urban-based South African higher education institution (HEI) in KwaZulu-Natal, Durban, South Africa.

Methods: A descriptive, exploratory qualitative approach was used. The target population was 4th-year psychiatric nursing students (N = 39) studying for the degree of Bachelor of Nursing at the preselected university, utilising two focus groups (n = 5, n = 7). Data were analysed through content analysis using the clinical reasoning model as a framework.

Results: Three categories (trigger problem, re-visioning the cues, treatment direction) and seven sub-categories (trigger problem posing, early cue identification, cue interpretation and clustering, focussed cue investigation, information processing and interpretation, reprioritise hypotheses, and diverse intervention[s]) emerged.

Conclusion: Psychiatry, Nursing and Midwifery practices require a practitioner skilled in HOTS to provide quality, efficient and cost-effective patient care.

Contribution: The findings in this study can benefit nursing education, particularly learning interruptions in HEIs.


higher order thinking skills; psychiatry; nursing students; online assessment; problem based assessment.

Sustainable Development Goal

Goal 4: Quality education


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