Alfaro-LeFevre Circular Model for Competence Assessment

In 2015, an instrument was designed based on the Alfaro-LeFevre model in order to evaluate the critical thinking of care nurses at the Hospital Universitari Vall d’Hebron.

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The need for more user-centred care and of evidence-based practices are aspects which highlight critical thinking as a professional competence. At a theoretical level, Alfaro-LeFevre put forth a thinking model based on four elements: personal characteristics, intellectual abilities, interpersonal and self-management abilities and technical abilities. However, no instrument has been found for its empirical evaluation.
Psychometric and correlation descriptive study. A set of elements was generated and a panel of experts evaluated the validity of the content of the new instrument based on the Alfaro-LeFevre circular model. Afterwards, the validation was performed on a sample of 339 nursing professionals at the Hospital Vall d’Hebron (Barcelona), who were selected by stratified sampling with proportional allocation of their units, between March and April 2015.
The validity index of the Nursing Practice Critical Thinking Evaluation Questionnaire content (in Spanish, CuPCPE) was 0.85. The alpha Cronbach overall value was 0.96. The coefficient of intra-class correlation was 0.77. The factorial confirmatory analysis showed that the resulting model adapted to the theoretical four-dimensional theoretical model proposed. Care nurses were observed to present moderate levels of critical thinking. Among other noteworthy results, statistically significant differences were found (p < 0.001) between levels of critical thinking skills and age, years of professional experience, care unit, years of experience at the same care unit, work shift, kind of labour contract and academic level.
Critical thinking is related to specific sociodemographic and professional variables. The CuPCPE psychometric properties reinforce its use in the clinical environment and in future studies.
Source of information: Avaluació del pensament crític en infermeres d’hospitalització segons el model circular d’Alfaro-LeFevre [Internet]. Catalonia [query performed on September 8, 2018]. Available at 


-       To know the level of critical thinking of the nursing collective at the hospital.
-       To study the Alfaro-LeFevre circular model.

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Published on*** 9 Sep 2018


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