Nursing Education Fundamentals: Assessment Design and Evaluation

Introduction to Nursing Formative Assessment

Coursework early in a nursing education program covers a broad range of topics, and an extensive amount of detail must be committed to memory. Assessments that are directly tied to coursework are primarily formative assessments, which demonstrate ongoing learning over the period of a course. Formative assessments generally take the form of quizzes and clinical demonstrations of a particular knowledge set recently covered in a class or series of classes. Summative assessments are generally used at the end of a course to evaluate the overall learning that has taken place; they include final exams, practicum demonstrations, and capstone projects.

The focus of this assessment project is a formative criterion-referenced test of general, fundamental nursing education knowledge. The items used in the test are included in Appendix A — Nursing Education — Fundamental Concepts. Twelve individuals were approached to take the exam as though it were an actual assessment of their knowledge; of the twelve candidates, ten agreed to complete the exam. The general exam is useful for students to gauge their learning and recall of basic concepts acquired during the early phase of their program. A collection of comprehensive tests at this and more advanced levels can also serve as a basis for preparing for state board exams. The results of the examination for the ten individuals are shown in aggregate form below.

Planning and Development of the Exam

To arrive at a comprehensive test of basic nursing concepts, the planning and development process addressed several common areas in nursing education. The objective was to achieve a balance of question items across several different areas of the fundamental nursing knowledge base. A variety of resources were used to arrive at the item selection, including professional standards and competencies, learnings from previous coursework, and personal experience. The content areas and their respective proportions of the exam are as follows:

Bloom's Revised Taxonomy Framework

Levels of Bloom's Taxonomy were used to organize the test items and to achieve a balance of item difficulty and knowledge scope. The levels introduced in the original taxonomy in 1959 include application, analysis, comprehension, and knowledge (Bloom, 1969; Anderson et al., 2001). However, this assessment uses the revised taxonomy from 2001 (see Appendix B — Bloom's Taxonomy Revised), which employs the following cognitive process categories:

The six cognitive processes are grounded in knowledge, which is further divided in the revised taxonomy into the following types:

Conclusion

The nursing education fundamentals exam was found to be both reliable and valid, demonstrating utility for nursing student preparation for summative exams. The exam is also useful as a self-assessment tool for nursing students to learn more about their orientation to tests that cover a wide variety of topics after a substantive amount of time has passed since initial instruction.

References

Anderson, L. W., Krathwohl, D. R., & Bloom, B. S. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives. New York: Longman.

Armstrong, P. (2015). Bloom's Taxonomy. Nashville, TN: Center for Teaching, Vanderbilt University. Retrieved from http://cft.vanderbilt.edu/guides-sub-pages/blooms-taxonomy/

Billings, D. M., & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty (3rd ed.). St. Louis, MO: Saunders Elsevier.

Bloom, B. S. (1969). Taxonomy of educational objectives: The classification of educational goals: Handbook I, Cognitive domain. New York: McKay.

Fundamentals of nursing exams. RNPedia. Retrieved from http://www.rnpedia.com/practice-exams/fundamentals-of-nursing-exams/fundamentals-nursing-practice-exam-4/

Appendix A: Nursing Education — Fundamental Concepts

Source: RNPedia.

1. A sudden redness of the skin is known as:
A. Flush   B. Cyanosis   C. Jaundice   D. Pallor

2. The term gavage indicates:
A. Administration of a liquid feeding into the stomach   B. Visual examination of the stomach   C. Irrigation of the stomach with a solution   D. A surgical opening through the abdomen to the stomach

3. A patient states that he has difficulty sleeping in the hospital because of noise. Which of the following would be an appropriate nursing action?
A. Administer a sedative at bedtime, as ordered by the physician   B. Ambulate the patient for 5 minutes before he retires   C. Give the patient a glass of warm milk before bedtime   D. Close the patient's door from 9 PM to 7 AM

4. Which of the following nursing theorists developed a conceptual model based on the belief that all persons strive to achieve self-care?
A. Martha Rogers   B. Dorothea Orem   C. Florence Nightingale   D. Sister Callista Roy

5. Which of the following nursing theorists is credited with developing a conceptual model specific to nursing, with man as the central focus?
A. Martha Rogers   B. Dorothea Orem   C. Florence Nightingale   D. Sister Callista Roy

6. Which of the following questions is most appropriate to ask when interviewing a potential candidate for an RN position?
A. What was your last nursing experience?   B. Are you willing to do overtime on weekends?   C. How many children do you have?   D. Do you plan to get pregnant?

7. If a patient is injured because a nurse acted in a wrongful manner, which party could be held liable along with the nurse?
A. The private attending physician   B. The nursing supervisor   C. The hospital   D. All of the above

8. Which of the following may be considered a patient's right?
A. The right to euthanasia   B. The right to refuse treatment   C. The right to ignore hospital regulations   D. The right to refuse to pay for what the patient considers to be inferior service

9. If a patient sues a nurse for malpractice, the patient must be able to prove:
A. Error, proximal cause, and lack of concern   B. Error, injury, and proximal cause   C. Injury, error, and assault   D. Proximal cause, negligence, and nurse error

10. Which communication skill is most effective in dealing with covert communication?
A. Validation   B. Listening   C. Evaluation   D. Clarification

11. Which of the following qualities are relevant in documenting patient care?
A. Accuracy and conciseness   B. Thoroughness and currentness   C. Organization   D. All of the above

12. The usual sequence for assessing the bowel is:
A. Right lower quadrant, right upper quadrant, left upper quadrant, left lower quadrant   B. Right lower lobe, right upper lobe, left upper lobe, left lower lobe   C. Right hypochondriac, left hypochondriac, and umbilical regions   D. Rectum, pancreas, stomach, and liver

13. The nurse should take a rectal temperature of a patient who has:
A. An arm in a cast   B. Nasal packing   C. External hemorrhoids   D. Gastrostomy feeding tubes

14. Blood pressure measurement is an important part of the patient's database. It is considered to be:
A. The basis of the nursing diagnosis   B. Objective data   C. An indicator of the patient's well-being   D. Subjective data

15. Postural drainage to relieve respiratory congestion should take place:
A. Before meals   B. After meals   C. At the nurse's convenience   D. At the patient's convenience

16. The correct site at which to verify a radial pulse measurement is the:
A. Brachial artery   B. Apex of the heart   C. Temporal artery   D. Inguinal site

17. S1 is heard best at the:
A. 5th left intercostal space along the midclavicular line   B. 3rd intercostal space to the left of the midclavicular line   C. Second right intercostal space at the sternal border   D. Second left intercostal space at the sternal border

18. The nurse's main priority when caring for a patient with hemiplegia is:
A. Educating the patient   B. Providing a safe environment   C. Promoting a positive self-image   D. Helping the patient accept the illness

19. Constipation is a common problem for immobilized patients because of:
A. Decreased peristalsis and positional discomfort   B. An increased defecation reflex   C. Decreased tightening of the anal sphincter   D. Increased colon motility

20. Antiembolism stockings are used primarily to:
A. Promote venous circulation   B. Provide external warmth   C. Prevent dependent edema   D. Hold foot dressings

21. To promote correct anatomical alignment in a supine patient, the nurse should:
A. Place the patient's feet in dorsiflexion   B. Place a pillow under the patient's knees   C. Hyperextend the patient's neck   D. Adduct the patient's shoulder

22. An appropriate interdependent intervention to prevent thrombophlebitis would be:
A. Elevate the knee gatch of the bed   B. Massage the legs vigorously   C. Apply antiembolism stockings to both legs   D. Encourage the patient to sit with his knees crossed

23. The average daily amount of urine excreted by an adult is:
A. 500 to 600 ml   B. 800 to 1,400 ml   C. 1,000 to 1,200 ml   D. 1,500 to 2,000 ml

24. According to Maslow's hierarchy of needs, which of the following is a basic physiological need after oxygen?
A. Activity   B. Safety   C. Love   D. Self-esteem

25. A patient is admitted to the hospital with a diagnosis of pneumonia and COPD. The physician orders oxygen therapy. The most comfortable method of delivering oxygen to this patient is by:
A. Croupette   B. Nasal cannula   C. Nasal catheter   D. Partial rebreathing mask

Appendix B: Bloom's Taxonomy Revised (2001)

Source: Armstrong, P. (2015). Bloom's Taxonomy. Nashville, TN: Center for Teaching, Vanderbilt University.

Remember: Recognizing; Recalling

Understand: Interpreting; Exemplifying; Classifying; Summarizing; Inferring; Comparing; Explaining

Apply: Executing; Implementing

Analyze: Differentiating; Organizing; Attributing

Evaluate: Checking; Critiquing

Create: Generating; Planning; Producing

In the revised taxonomy, knowledge forms the basis of these six cognitive processes, but its authors created a separate taxonomy of the types of knowledge used in cognition:

Factual Knowledge: Knowledge of terminology; knowledge of specific details and elements

Conceptual Knowledge: Knowledge of classifications and categories; knowledge of principles and generalizations; knowledge of theories, models, and structures

Procedural Knowledge: Knowledge of subject-specific skills and algorithms; knowledge of subject-specific techniques and methods; knowledge of criteria for determining when to use appropriate procedures

Metacognitive Knowledge: Strategic knowledge; knowledge about cognitive tasks, including appropriate contextual and conditional knowledge; self-knowledge