Patient Safety Competency Test Blueprint for Nursing Students
This paper presents a test blueprint for evaluating patient safety competency in nursing students, grounded in four learning goals derived from major healthcare standards bodies. Drawing on the ANA Code of Ethics, Institute of Medicine recommendations, AACN graduate-level QSEN competencies, and The Joint Commission's National Patient Safety Goals, the blueprint maps multiple-choice and essay questions to Bloom's Taxonomy cognitive process dimensions — from remembering and understanding through applying, analyzing, evaluating, and creating. Sample test items with model answers are provided for each learning goal, demonstrating how assessment design can reinforce the knowledge, skills, and attitudes nursing students need to promote patient safety in clinical practice.
- Introduction: Patient Safety and Nursing Education: Policy context linking nursing errors, ethics, and reform
- Nursing Ethics and Patient Safety: ANA Code of Ethics provisions and sample test items
- Primary Nursing Education and Patient Outcomes: IOM BSN recommendations and competency assessment questions
- National Patient Safety Goals: Systems and Practice: Essay question on bar coding and systems implementation
- Utilizing The Joint Commission Website: Creating and locating goals via Joint Commission resources
- Test Blueprint Structure and Bloom's Taxonomy: Question distribution formula and appendix grid breakdown
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What makes this paper effective
- The blueprint explicitly connects each test item to a Bloom's Taxonomy cognitive process dimension and a specific learning objective/outcome verb, making the assessment rationale transparent and reproducible.
- Sample questions with answer keys (including distractor analysis) are provided for every learning goal, giving readers a concrete, ready-to-use model rather than an abstract framework.
- The paper draws on credible, authoritative sources — the ANA Code of Ethics, IOM Future of Nursing report, AACN QSEN competencies, and Joint Commission National Patient Safety Goals — and aligns each learning goal to a specific policy recommendation.
Key academic technique demonstrated
The paper demonstrates criterion-referenced assessment design: each test item is reverse-engineered from a stated learning goal and a chosen cognitive level, rather than written ad hoc. This technique, rooted in Bloom's Taxonomy, ensures that the assessment instrument measures exactly what the curriculum intends to teach.
Structure breakdown
The paper opens with a policy rationale grounding patient safety in both ethics and regulation, then states four learning goals. Subsequent sections address each goal in sequence, specifying cognitive dimensions, sample questions, and model answers. The appendix provides a Bloom's Taxonomy grid quantifying question distribution across cognitive domains. This logical scaffolding — from rationale to goals to items to blueprint math — mirrors standard instructional design practice.
Introduction: Patient Safety and Nursing Education
Ever since the report To Err is Human was published in 2000 by Kohn and colleagues, healthcare stakeholders in Western countries have intensified reform efforts designed to increase patient safety. The report revealed that nearly 100,000 patients were dying annually from medical errors in the 1990s — a statistic that caught the attention of legislators, healthcare policymakers, clinicians, patients, and the general public. Additional research revealed that nurses were considered to be both the source of most medical errors and the best defense against errors, yet nurses had little, if any, control over patient care planning (Lachman, 2007). Systems were therefore a major determinant of patient safety.
Patient safety and nursing ethics are also inseparable (Lachman, 2007, p. 401). While avoiding specific recommendations, Provision 3 of the American Nurses Association Code of Ethics states that nursing professionals must protect the safety of patients; however, fulfilling this goal requires nurses to report procedures, practices, or staff endangering patient safety to management. A similar conclusion can be reached with Provision 6, which states that nurses should promote a moral environment. These Code of Ethics provisions reveal that patient safety and ethics are not mutually exclusive, and that ethics should be a core element of any nursing education curriculum.
Contemporary patient safety guidelines have been published by a number of stakeholders, including the Joint Commission (2015), the American Association of Colleges of Nursing (AACN, 2012), and the Institute of Medicine (2010). The Institute of Medicine (2010) recommends increasing the prevalence of bachelor-prepared RNs and residency programs — reforms intended to increase the breadth and depth of nursing competencies and stabilize the workforce. The AACN (2012) developed guidelines for nursing education curricula designed to teach nursing students the knowledge, skills, and attitudes needed for improving and ensuring care quality and safety. In particular, well-trained nurses should be able to analyze how national patient safety regulations and guidelines will affect systems and practice, design and implement quality improvement projects, and understand the value of national patient safety initiatives in relation to system and practice improvements.
While the Institute of Medicine and AACN recommendations for patient safety are conceptual in nature, The Joint Commission (2015) has published specific and detailed recommendations for ensuring patient safety in acute care facilities seeking accreditation. For example, primary source verification of nursing education need not be done in most cases if the independent practitioner holds a current license to practice, since licensing boards verify primary education sources before licensure is granted. Accordingly, this test blueprint focuses on the following four learning goals:
- Understand the relationship between nursing ethics and patient safety
- Understand the relationship between primary nursing education and patient outcomes
- Understand how implementation will affect systems and practice
- Utilize National Patient Safety Goals published by The Joint Commission
References
AACN (American Association of Colleges of Nursing). (2012). Graduate-level QSEN competencies knowledge, skills, and attitudes. Retrieved from http://www.aacn.nche.edu/faculty/qsen/competencies.pdf.
Clark, C. C. (2008). Classroom Skills for Nurse Educators. Sudbury, MA: Jones and Bartlett Publishers.
IAR (Instructional Assessment Resources). (2011). Assess Students: Multiple-choice questions. Retrieved from
Institute of Medicine. (2010). The future of nursing: Focus on education. Retrieved from https://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Nursing%20Education%202010%20Brief.pdf.
Kohn, K. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: Building a Safer Health System. Washington, D.C.: National Academy Press.
Lachman, V. D. (2007). Patient safety: The ethical imperative. Medsurg Nursing, 16(6), 401–3.
Lachman, V. D. (2009a). Practical use of the nursing code of ethics: Part I. Medsurg Nursing, 18(1), 55–7.
Lachman, V. D. (2009b). Practical use of the nursing Code of Ethics: Part II. Medsurg Nursing, 18(3), 191–4.
The Joint Commission. (2015). National Patient Safety Goals: 2015 National Patient Safety Goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx.
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