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DEVELOPING AND USING CLASS ROOM TEST - WRITING TEST ITEMS.pptx
The document discusses the use of drag and drop and ordered response questions to assess clinical judgment and decision-making skills in nursing education, referencing the NCSBN clinical judgment measurement model. It emphasizes the importance of clinical judgment for entry-level nurses in providing safe patient care, integrating theoretical frameworks for assessment. Additionally, it outlines specific types of questions and instructional strategies used to enhance nursing students' critical thinking and clinical decision-making abilities.
DEVELOPING AND USING CLASS ROOM TEST - WRITING TEST ITEMS.pptx
- 1. DEVELOPING AND USING CLASSROOM TEST - WRITING TEST ITEMS:
- 2. “DRAG & DROP,ORDERED RESPONSE QUESTIONS AND GRAPHIC ITEMS” Dr.K.Prema Sekar Principal Shri Sathya Sai College of Nursing Sri Balaji Vidyapeeth (Deemed to be University)
- 3. NURSING AND CLINICALJUDGEMENT Kavanaugh and Szweda (2017) have identified a deficit in clinical judgment exists with entry-level nurses.
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- 6. DEVELOPMENT OF NCSBNCLINICAL JUDGMENT MEASUREMENT MODEL
- 7. CLINICAL JUDGMENT MODEL FRAMEWORK •Three predominant nursing theoretical frameworks for assessing clinical judgment. – Intuitive-Humanistic Model (Benner) – Dual Process Reasoning Theory/Model – Information Processing Model • Nursing clinical judgment is difficult to define.
- 8. • Clinical judgmentis defined as the observed outcome of critical thinking and decision-making. – It is an iterative process that uses nursing knowledge to observe and assess presenting situations. – identify a prioritized client concern. – generate the best possible evidence-based solutions in order to deliver safe client care. - NCSBN JAN 2015
- 9. WHY DRAG ANDDROP QUESTIONS? • To assess a prospective nurse’s clinical judgment abilities and decision-making skills within the context of a high-stakes exam. • Newer alternate format question types introduced by the NCSBN.
- 10. DRAG AND DROP •These questions ask you to place answers in a specific order. • Items allow candidates to select one or more answer options at a time. • Items allow candidates to move or place response options into answer spaces.
- 11. PURPOSE OF DRAGAND DROP • Focus is solely on measurement of clinical judgement. • Does not replace the current models of teaching / learning. • Does not replace nursing process.
- 12. uworld.com 972.887.3293 support@uworld.com 9111Cypress Waters Blvd., Suite 300, Irving, Tx 75019 Using the CJMM as a teaching strategy FORM HYPOTHESES REFINE HYPOTHESES EVALUATE OUTCOMES EXPLANATION REVIEW
- 13. Form Hypotheses Refine Hypotheses Evaluation 1. Read the stemand envision the scenario 2. Hypothesize: -What is currently happening with the client? -What needs to happen? -When? 3. Eliminate any known incorrect options 4. Which options satisfy the hypothesis? 5. Consider the result of each remaining option. 6. Select the correct option. Explanation Review 7. Review correct and incorrect explanations 8. Space out your practice over time The nurse finds a client’s femoral arterial line dislodged and profuse bleeding coming from the site. The client is pale and lethargic. What action should the nurse take first? 1. Take the client’s blood pressure 2. Hold pressure on the site and call for help 3. Page the healthcare provider 4. Place the client in a high Fowler’s position First step: Stop the bleeding Assessment isn’t the priority right now!
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- 16. APPLYING THE CJTASK MODEL IN EDUCATION • Cognitive Operations = Layer 3 . • Factor Conditioning = Layer 4 . • Expected behaviors/actions = appropriate student actions or observable outcomes. • The CJ Model assesses if a student is able to make an appropriate nursing clinical judgment by following the cognitive operations through an entire case study.
- 17. TYPES OF DRAGAND DROP • Cloze (Drag and Drop) • Drag and Drop rationale • Bowtie
- 18. CLOZE (DRAG ANDDROP) • Features of Cloze – There is a dropdown list of options in each box. – Embedded answer questions including multiple choice, short answers, and numerical answers.
- 19. EXAMPLE 1 After diagnostictesting is completed, the client is diagnosed with a cataract of the right eye. The physician recommends removal of the cataract. The client verbalizes, “ I am afraid of surgery and becoming blind”. Drag the choices below to fill in the following sentence. Each choice will only be used once. The Client’s needs the nurse addresses at this time include ______, _______ and ______. Answer Choices Anxiety Depression Knowledge deficit Preoperative pain Risk for injury Self care deficit
- 20. EXAMPLE 2 Nurses Notes •Day 1: Client identifies that there is no prior history of Antihypertensive • A medication use. Client denies knowledge of drug effects and medication precautions. Client states currently experiencing a headache, 4 on a numeric 0-to-10 pain scale. Client takes Chlorthalidone and Lisinopril tables with out difficulty. The Nurse administer the initial dose of medication as prescribed in the nurses notes. Drag from word choices to complete the sentences The Nurse identifies the priority problem as , , and Word Choices Nutritional deficit Altered cardiac output Anxiety Insufficient knowledge of Medication Reduced Oxygenation Pain
- 21. DRAG AND DROP(RATIONALE) • Nurses Notes Day 1: Client identifies that there is no prior history of antihypertensive medication use. Client denies knowledge of drug effects and medication precautions. Client states currently experiencing a headache, 4 on a numeric 0-to- pain scale. Client takes Chlorthalidone and Lisinopril tables with out difficulty. Day 2: Administer daily doses of chlorthalidone mg PO and Lisinopril mg daily. No current headache reported. Client has slept through night The client experiences dizziness several hours after administration of antihypertensive medication on hospital day 2 which the nurse documents in the nurses notes. Drag one condition and client findings to complete the sentences. The Nurse determines that the client is experiencing as a result of Option for 1 Option for 2 Apnea Orthostatic Hypotension Anxiety Insufficient food intake Pain Medication side effects
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- 24. EXAMPLE 1 • Historyand Physical Examination A 72-Year-old female with severe arthritis of the hands has trouble using toilet due to physical limitations, causing involuntary loss of urine and loss of bladder control. Client states that she has an accident before she ever reaches the toilet. She has no urgency, pain, or burning upon urination. Abdomen is soft and non tender. Manual dexterity of her hands is limited. Her gait is slow but steady, She is embarrassed when the episodes occur and has reduced her social activities. The client has started to limit her intake of fluids to decrease the number of episodes she experiences. Her weight is within normal limits After the client is admitted to the medical unit, the nurse reviews the history and physical imaging studies to plan care. Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address the condition, and two parameters the nurse should monitor to assess the clients progress. Action to Take Action to Take Request a prescription for a diuretic from the health care provider Irrigate the bladder with sterile normal saline Contact health care provider for insertion of a retention catheter Encourage client to drink fluids Assist the client to the bathroom every 2 hours during the day Potential Conditions Stress Incontinence Polyuria Functional Incontinence Dysuria Parameter to monitor Understanding of Urinary diversion home care Vital signs Color of urine in catheter bag Intake and Output Frequency of episodes
- 26. EXAMPLE 2 • Thenurse is reviewing the client’s assessment data to prepare the client’s plan of care. – Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing , 2 actions the nurse should take to address that condition and 2 parameters the nurse should monitor to assess the client’s progress Condition Most Likely Experiencing Parameter to Monitor Parameter to Monitor Action to Take Action to Take Action to take Request a prescription for on oral steroids Administer oxygen at 2L/min via nasal cannula Insert a peripheral venous access device Obtain a urine sample for urine analysis and culture and sensitivity ( C&S) Potential conditions Bell’s palsy Hypoglycaemia Ischemic stroke Urinary tract infection (UTI) Parameters to Monitor Temperature Urinary output Neurologic status Serum glucose level Electrocardiogram (ECG) rhythm
- 27. Bowtie Scoring Action toTake Condition Most Likely Experiencing Action to Take Parameter to Monitor Parameter to Monitor • Each target is worth 1 point • Some of all correct responses • Maximum 5 points Target
- 28. Item Writing Tips •Rest and review • Are You consistent ? • Are all answer options Plausible? • Did you provide clues about the correct response(s)?
- 29. ODERED RESPONSE QUESTIONS •Ordered response questions present several answer options . • They are difficult because all options are correct. • Nurse must consider multiple true statements in sequential order or by importance.
- 30. EXAMPLE - 1 •A community nurse is leading a support group discussion on the progressive nature of multiple sclerosis (MS). Arrange the following degenerative changes in the order in which they occur. Use all of the options. 1. Degeneration of axons 2. Demyelination throughout the central nervous system 3. Plaque formation that interrupts nerve impulses 4. Periodic and unpredictable exacerbations and remissions • Answer: 2, 1, 4, 3
- 31. EXAMPLE - 2 •The nurse is assisting in cystometrography. Place in chronological order the sequence of events for this procedure. Use all the options. 1. Client is asked to void normally. 2. Urinary catheter is inserted. 3. Any residual urine is noted. 4. Fluid is instilled into the urinary catheter 5. Client is asked to void following instillation. 6. Urge to void is recorded Answer: 1, 2, 4, 6, 5, 3
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- 33. TIPS WHEN ANSWERING ORDERED-RESPONSEQUESTIONS • Questions are usually about nursing procedures. Imagine yourself performing the procedure to help you answer these questions. • You’ll have to place the options in correct order by clicking an option and dragging it on the box on the right. You can rearrange them before you hit submit for your final answer.
- 34. GRAPHICS QUESTIONS 1. Graphicsquestions presents a question with several answer options that are illustrations, Pictures, photographs, charts, or graphs rather than text. 2. Select the option with the illustration that answers the questions. 3. On a computer , each option is preceded by circle.
- 35. EXAMPLE - 1 •A public health nurse is screening children for nutritional deficiencies. Which illustration depicts a child who is likely experiencing scurvy (vitamin C deficiency)
- 36. EXAMPLE - 2 •A nurse is planning care for a client who is to receive a radiation treatment later in the day. In preparing the client’s room, which sign should the nurse plan to post outside the client’s room? A B C D
- 37. EXAMPLE - 3 Aclient with severe aortic stenosis is scheduled for valve replacement. While teaching the client about his condition and upcoming surgery, the nurse shows him a heart illustration (upper right). Identify the valve that the nurse should indicate will be replaced.
- 38. SUMMARY • The mostrecent practice analysis says that the nurses are caring for more critically ill patients and are responsible for making increasingly complex decisions and judgements regarding the care. • The NSG supervisors, RN licensed & Nurse educators identifying that clinical judgement is important to NSG practice. so clinical judgement is essential for entry level nurses to provide safe care . • Developing effective communication skills goes hand in hand with developing sound clinical judgement.
- 39. REFERENCES Cox-Davenport, R. A.,& Phelan, J. C. (2015). Laying the groundwork for NCLEX success: An exploration of adaptive quizzing as an examination preparation method. Computers, Informatics, Nursing, 33(5), 208–215. https://doi.org/10.1097/CIN.0000000000000140 Dunlosky, J., Rawson, K. A., Marsh, E. J., Mitchell, N. J., & Willingham, D. T. (2013). Improving students' learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public Interest, 14(1), 4–58. https://doi.org/10.1177/1529100612453266 Dunn, D. S., Saville, B. K., Baker, S. C., & Marek, P. (2013). Evidence-based teaching: Tools and techniques that promote learning in the psychology classroom. Australian Journal of Psychology, 65(1), 5–13. https://doi.org/10.1111/ajpy.12004 Karpicke, J. D., & Grimaldi, P. J. (2012). Retrieval-based learning: A perspective for enhancing meaningful learning. Educational Psychology Review, 24, 401–418. https://doi.org/10.1007/s10648-012-9202-2 National Council of State Boards of Nursing. (n.d.-a). Computerized adaptive testing (CAT). NCSBN. Retrieved April 8, 2021, from https://www.ncsbn.org/1216.htm National Council of State Boards of Nursing. (n.d.-b). Creating the NCLEX and passing standard. NCSBN. Retrieved April 8, 2021, from https://www.ncsbn.org/9011.htm
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Editor's Notes
- #2 Newer alternate format question type
- #3 DISCUSS ABOUT NCSBN CLINICAL JUDGEMENT RESEARCH research and clinical judgement model
- #5 Recent evidences also supports these research Top 3 Areas Identified: 1. Clinical Judgment 2. Professional Communications 3. Active Listening
- #15 This layer provides context for the clinical judgment items • The white bubbles correspond to external factors such as the setting or resources available • The gray bubbles correspond to internal factors such as the nurse’s knowledge and experience
- #22 Item includes 1 sentence with 1 cause and 1 effect or 1 sentence with one cause and 2 effects. This can be a single dyad (1 sentence with 2 targets) or a single triad (1 sentence with 3 targets). Students can select a token on top of a target and remove it by either dragging it back to the token list or just removing it.
- #34 Place the cursor in the circle and click the mouse to select the desired answer, when answering graphic item in a textbook, you are present with an illustration and must select one answer from among several options or you are asked a question and must select one answer from among several options, each having illustration,
- #37 FEATURES Heard about the new NCLEX? Nursing: January 2004 - Volume 34 - Issue - p 34 FREE AbstractIn Brief Here's what the buzz is about on alternative-item questions. RECENTLY, THE NATIONAL COUNCIL of State Boards of Nursing (NCSBN) added three types of alternative-item questions to the licensing exam it administers. Here are some examples of the new types of questions in the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and the National Council Licensure Examination for Practical/Vocational Nurses (NCLEX-PN). 1. Multiple-response multiple-choice questions These questions may have more than one correct answer and may contain more than four possible answer options. You'll be asked to select all the answers that apply, not just the best answer. Sample question (and answer with rationale) While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which of the following interventions? Select all that apply: □ A. Administer a preparation to clean the GI tract, such as Golytely or Fleet Phospho-Soda. □ B. Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure. □ C. Tell the client he must be on a clear liquid diet for 24 hours before the procedure. □ D. Inform the client that he'll receive a sedative before the procedure. □ E. Tell the client that he may eat and drink immediately after the procedure. Answer B, D Rationale The client shouldn't eat or drink for 6 to 12 hours before the procedure to ensure that his upper GI tract is clear for viewing. The client will receive a sedative before the endoscope is inserted that will help him relax, but allow him to remain conscious. A GI tract cleansing and a clear liquid diet are interventions for a client having a lower GI tract procedure, such as a colonoscopy. Food and fluids must be withheld until the gag reflex returns. 2. Fill-in-the-blank questions These questions require you to provide the answer yourself, rather than select it from a list of options. On the computerized test, you'll type your answer in the blank space provided after the question. Keep in mind that you may need to type in a very specific response for it to be considered correct, so be sure to read the question carefully. Sample question (and answer with rationale) A client is admitted with a diagnosis of diabetic ketoacidosis. An insulin drip is initiated with 50 units of insulin in 100 ml of normal saline solution. The I.V. solution is being infused via an infusion pump and the pump is currently set at 10 ml/hour. The nurse determines that the client is receiving how many units of insulin each hour? Answer 5 units of insulin Rationale To determine the number of insulin units the client is receiving per hour, the nurse must first determine the number of units in each milliliter of fluid (50 unit/100 ml = 0.5 unit/ml). Next, she multiplies the units/ml by the rate of ml/hour (0.5 units × 10 ml/hour = 5 units). 3. Illustrated/graphic questions In these questions, you'll be asked to identify an area on a picture or graphic. On the computerized exam, you'll place your cursor over the correct area on an illustration. Sample question (and answer with rationale) A client with severe aortic stenosis is scheduled for valve replacement. While teaching the client about his condition and upcoming surgery, the nurse shows him a heart illustration (upper right). Identify the valve that the nurse should indicate will be replaced. FigureAnswer (See illustration at lower right.) Rationale The aortic valve is located between the left ventricle and the aorta. It's one of the semilunar valves and normally has three cusps. A person with a bicuspid aortic valve is at risk for both aortic stenosis and aortic regurgitation.