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Past and Current Trends in the NCLEX-RN ®. Mary J. Yoho, PhD., R.N., CNE Director of Faculty Development & Consultation Elsevier Health Science [email protected] Today’s Students. Resources for Developing Critical Thinking Test Items and Alternate Format Questions. www.ncsbn.org

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Past and current trends in the nclex rn l.jpg

Past and Current Trendsin theNCLEX-RN®

Mary J. Yoho, PhD., R.N., CNE

Director of Faculty Development & Consultation

Elsevier Health Science

[email protected]



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Resources for Developing Critical Thinking Test Items and Alternate Format Questions

www.ncsbn.org

NCLEX Test Plans

2007 & 2010 RN

2008 PN

Candidate info

Alternate format items

Innovative Items

Test Taking

3


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2007 NCLEX-RN® Test Plan Additions Alternate Format Questions

  • Disaster Planning

  • Ergonomic Principles

  • Accident and Error Prevention

  • Clients with non-substance-related dependencies

    • Gambling, sexual addiction, pornography

  • Therapeutic Environment

  • Complimentary & Alternative Therapies

    • Music and relaxation therapy


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2010 NCLEX-RN Alternate Format Questions® Test Plan Distribution of Content

Safe & Effective Care

Management of Care

Safety & Infection Control

Health Promotion & Maintenance

Psychosocial Integrity

Physiological Integrity

Basic Care & Comfort

Pharmacological & Parenteral Therapies

Reduction of Risk Potential

Physiological Adaptation

2007

13-19%

8-14%

6-12%

6-12%

6-12%

13-19%

13-19%

11-17%

2010

16-22%

8-14%

6-12%

6-12%

6-12%

13-19%

10-16%

11-17%

5


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NCLEX-RN® Annual Alternate Format QuestionsPass RatesUS Educated Graduates


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Critical Thinking Item Writing Alternate Format Questions

One of the best preparations for student success on NCLEX® is to test like NCLEX®


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i-clicker Question Alternate Format Questions

  • Which objective of the Critical Thinking and Test Item Writing Workshopis most important for you?

  • Evaluate exam items for their ability to test critical thinking.

  • Ability to measure an exam’s reliability and validity.

  • Develop an exam blueprint that reflects a valid exam.

  • Interjecting alternate format questions into your curriculum and exams.


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9 Alternate Format Questions


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Additional NCLEX Resources Alternate Format Questions

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Internal and External Alternate Format Questions

Curriculum Evaluation

Outcome Predictors

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External Curriculum Evaluation Alternate Format Questions

Compare Individual Group with Population at Large

  • Standardized Exams

  • NCLEX-RN

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Internal Curriculum Evaluation Alternate Format Questions

Evaluation Tools Used in your Program

  • Teacher-made Exams

  • Clinical Evaluation Forms

  • Skills Lab Check-off Forms

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Internal Curriculum Evaluation Alternate Format Questions

Evaluation of course objectives (faculty designed or outsourced)

  • Writing Critical Thinking Test Items

  • Item Analysis Software

  • Test Item Banking Programs

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Five Guidelines to Developing Effective Critical Thinking Exams

  • Assemble the “basics.”

  • Write critical thinking test items.

  • Pay attention to housekeeping duties.

  • Develop a test blueprint.

  • Scientifically analyze all exams.

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Definition Exams

Critical Thinking

The process of analyzing and understanding how and why we reached a certain conclusion.

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Sound Instruction Exams

Educator’s

Golden

Triangle

Instruction

Objectives

Evaluation

Outcomes


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Reach the Golden Triangle Through Exams

Curriculum

Design


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Philosophy ExamsOutcomes Objectives

Instructional Methods

Evaluation Tools


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Definition Exams

Critical Thinking

The process of analyzing and understanding how and why we reached a certain conclusion.


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Paul Exams

Bloom

The Big Cheese

The Teacher’s Pet

Critical Thinking Test Items


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Bloom‘s Taxonomy: ExamsBenjamin Bloom, 1956(revised)

Terminology changes"The graphic is a representation of the NEW verbage associated with the long familiar Bloom's Taxonomy. Note the change from Nouns to Verbs [e.g., Application to Applying] to describe the different levels of the taxonomy. Note that the top two levels are essentially exchanged from the Old to the New version." (Schultz, 2005) (Evaluation moved from the top to Evaluating in the second from the top, Synthesis moved from second on top to the top as Creating.)Source: http://www.odu.edu/educ/llschult/blooms_taxonomy.htm


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Bloom’s Taxonomy Revised Terms Exams

Remembering: Retrieving, recognizing, and recalling relevant knowledge from long-term memory.

Understanding: Constructing meaning from oral, written, and graphic messages through interpreting, exemplifying, classifying, summarizing, inferring, comparing, and explaining.

Applying: Carrying out or using a procedure through executing, or implementing.

Analyzing: Breaking material into constituent parts, determining how the parts relate to one another and to an overall structure or purpose through differentiating, organizing, and attributing.

Evaluating: Making judgments based on criteria and standards through checking and critiquing.

Creating: Putting elements together to form a coherent or functional whole; reorganizing elements into a new pattern or structure through generating, planning, or producing.

(Anderson & Krathwohl, 2001, pp. 67-68)


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Richard Paul: Exams

“The art of thinking about your thinking while you are thinking in order to make your thinking better:

More Clear

More Accurate

More Defensible.”


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Post Analysis ExamsRELIABILITY

Helps to determine the quality of a test


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Reliability Exams

Consistency of Scores:

Determines the Quality of the Test

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Reliability Tools Exams

  • Kuder-Richardson Formula 20 (KR20)—EXAM

    • Range from –1 to + 1

  • Point Biserial Correlation Coefficient (PBCC)—TEST ITEMS

    • Range from – 1 to + 1

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Standards of Acceptance Exams

  • Item difficulty 30% - 90%

  • Item Discrimination Ratio 25% and Above

  • PBCC 0.15 and Above

  • KR20 0.60 and Above

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3-Step Method for Exams

Item Analysis

  • 1. Review Difficulty Level

  • 2. Review Discrimination Data

    • Item Discrimination Ratio (IDR)

    • Point Biserial Correlation Coefficient (PBCC)

  • 3. Review Effectiveness of Alternatives

    • Response Frequencies

    • Non-distracters

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Content Validity Exams

Does the test measure what it claims to measure?


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Content Validity Exams

  • Test Blueprint

    • Rational/Logical Pre-Assessment Tool

  • Database Programs

    • Storage of item discrimination data


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32 Exams


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33 Exams


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34 Exams


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Critical Thinking Test Items Exams

  • Contain Rationale

  • Written at the Application Level or Above

  • Require Multilogical Thinking to Answer

  • Ask for High Level of Discrimination

Morrison, Smith, & Britt (1996)

Morrison & Free (2001)

Morrison, in Caputi (2003)

Morrison, Nibert, & Flick (2006)

35


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Written at the Application Level and Above Exams

  • Prepare students for NCLEX

  • Promote thinking about clinical problems

  • Cause teaching methods to become creative

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Critical ExamsThinking Questions

  • Which intervention is most important?

  • Which intervention, plan, assessment data is/are most critical to developing a plan of care?

  • Which intervention should be done first?

  • What action should the nurse take first?

  • Which intervention, plan, nursing action has the highest priority?

  • What response is best?

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Item Writing Rules Exams

  • Get rid of names

  • Get rid of ‘multiple’ multiples

  • Use non-sexist writing style

  • Develop parsimonious writing style

    • Cross out “of the following”

    • Delete scenarios

  • Write items independent of each other

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… and More Rules Exams

  • Use a question format when possible

  • Make distracters plausible and homogeneous

    • Equal in length

    • No opposites

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Test Item Rationales Exams

Test Review

  • Learning Experience

  • Faculty Friendly

  • Legally Defensible

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… and More Rules Exams

  • Eliminate “all of the above” and “none of the above”

  • Rewrite any “all except” questions

  • Ensure that alternatives do not overlap

  • Vary correct answer

42


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… and the MOST IMPORTANT Rule Exams

Develop written testing policy

  • Writing style

  • Format

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The nurse knows that which assessment finding is characteristic of a client with Parkinson’s disease?

A.     Night blindness.

B.     Pain in lower extremities.

C.     Shuffling gait.

D.     Incontinence.

Answer: C

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  • The nurse is making a home visit to a 75-year-old male client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

  • The client’s wife tells the nurse that the grandchildren have not been to visit for over a month.

  • The nurse notes that there are numerous throw rugs throughout the client’s home.

  • The client has a towel wrapped around his neck that the wife uses to wipe her husband’s face.

  • The client is sitting in an arm chair, and the nurse notes that he is gripping the arms of the chair.

  • ANS: B

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Rationale client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

  • Parkinson’s disease is characterized by a shuffling gait, and throw rugs throughout the home pose a safety hazard for this client (B).

  • Visits from the grandchildren (A) may or may not be significant to this client, and the nurse should gather more information about the client’s feelings regarding such visits.

  • Drooling is also characteristic of Parkinson’s disease, and a towel wrapped around the client’s neck (C) may be a good means of keeping the client dry, however, the nurse may need to counsel the family to be sure the client is dry and clean.

  • Tremors are characteristic of Parkinson’s disease and grasping the arms of a chair (D) may help to control tremors in the hands and arms.

46


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i-clicker Question client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

Which element of a Critical Thinking Test Item do you feel is the most challenging to develop?

  • Stem

  • Responses

  • Rationale


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Alternate Format Questions client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

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Alternate Test Item Format client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

The National Council of State Boards of Nursing (NCSBN) currently identifies five types of alternate item formats

Multiple choice-multiple answer

Fill-in-the-blank test items

Hot-spots--identify an area on a picture or graphic

Drag and drop (Ranking)

Chart Exhibit

8% of NCSBN test items are alternate format test item format items.

49


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Hot Spot client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

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Ranking client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

51


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Fill-in-the-blank client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

52


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Calculator client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

53


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Multiple Choice-Multiple Answer client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

54


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Chart Exhibit client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?

55


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56 client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?


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57 client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?


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Home-Grown Alternate client who has had Parkinson’s disease for the past five years. Which finding has the greatest implication for this client’s care?Format Items

Standardized Testing

Computerized Testing

Skills Lab Practice

Add to Lecture

Clinical

Simulation

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When instilling a client’s eye drops, which technique(s) should the nurse include?

Apply gentle pressure over the inner canthus.

Apply firm pressure over the outer canthus.

Hold the dropper six inches above the eye.

Dab the cornea with a sterile cotton swab to absorb excess moisture.

Ask the client to look up while placing the drop.

Carefully drop the medication on the cornea.

A. 1, 2, 3, and 6.

B. 4, and 5

C. 3 and 6 only.

D. 1 and 5 only.

E. All of the above.

Improving the Multiple-Multiple Question

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When instilling a client’s eye drops, which technique(s) should the nurse include? (Select all that apply.)

Apply gentle pressure over the inner canthus.

Apply firm pressure over the outer canthus.

Hold the dropper six inches above the eye.

Dab the cornea with a sterile cotton swab to absorb excess moisture.

Ask the client to look up while placing the drop.

Carefully drop the medication on the cornea.

Change to

”Select All That Apply”

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Changing Multiple-Choice Questions should the nurse include? (Select all that apply.)

Which action should the nurse complete first when implementing prescriptions for a client newly admitted with urosepsis?

Administer the initial dose of Vancomycin.

Obtain a urine specimen for culture.

Notify lab personnel that peak and trough levels are needed.

Insert an indwelling urinary catheter.

Answer: D

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To Drag-Drop (Ranking) should the nurse include? (Select all that apply.)

In which sequence should the nurse implement the prescriptions for a client newly admitted with urosepsis?

Administer the initial dose of Vancomycin.

Obtain a urine specimen for culture.

Notify lab personnel that peak and trough levels are needed.

Insert an indwelling urinary catheter.

Answer: D-B-A-C

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Innovative Item Format should the nurse include? (Select all that apply.)

Test items include:

Identification on a picture, graph or chart

Graphics Interaction

Audio

Video

Animation

Decision Task Item Sets

Wendt & Harmes, Nurse Educator, March/April, 2009

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Graphics Interaction Item should the nurse include? (Select all that apply.)

Addressing Safety

Wendt & Harmes, Nurse Educator, March/April, 2009

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Video Interaction Addressing Communication Skills should the nurse include? (Select all that apply.)

Wendt & Harmes, Nurse Educator, March/April, 2009

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Home-Grown Innovative should the nurse include? (Select all that apply.)Format Items

Standardized Testing

Skills Lab Practice

Safety Lab

Add to Lecture

Photos of Safety Lab

Clinical

Simulation

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Faculty Activity should the nurse include? (Select all that apply.)

  • Select a multiple choice, critical thinking test item.

  • Revise to an alternate format or innovative question.

  • Evaluate test items presented.

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i-clicker Question should the nurse include? (Select all that apply.)

  • Will you implement the “Faculty Activity”: Write a critical thinking test item, Present test item to group, and Evaluate the test item?

  • No way…Not in this lifetime.

  • I’ll discuss this with the faculty.

  • Yes, at the next faculty meeting.

  • I have already identified 5 questions that I want immediate input for revision.


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Thank You!! should the nurse include? (Select all that apply.)

Mary J. Yoho, PhD, RN, CNE

[email protected]

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