Past and Current Trends in the NCLEX-RN ®

1. Past and Current Trendsin theNCLEX-RN® Mary J. Yoho, PhD., R.N., CNE Director of Faculty Development & Consultation Elsevier Health Science m.yoho@elsevier.com

2. Today’s Students

3. 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

4. 2007 NCLEX-RN® Test Plan Additions • 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

5. 2010 NCLEX-RN® 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

6. NCLEX-RN® Annual Pass RatesUS Educated Graduates

7. Critical Thinking Item Writing One of the best preparations for student success on NCLEX® is to test like NCLEX®

8. i-clicker Question • 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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10. Additional NCLEX Resources 10

11. Internal and External Curriculum Evaluation Outcome Predictors 11

12. External Curriculum Evaluation Compare Individual Group with Population at Large • Standardized Exams • NCLEX-RN 12

13. Internal Curriculum Evaluation Evaluation Tools Used in your Program • Teacher-made Exams • Clinical Evaluation Forms • Skills Lab Check-off Forms 13

14. Internal Curriculum Evaluation Evaluation of course objectives (faculty designed or outsourced) • Writing Critical Thinking Test Items • Item Analysis Software • Test Item Banking Programs 14

15. 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. 15

16. Definition Critical Thinking The process of analyzing and understanding how and why we reached a certain conclusion. 16

17. Sound Instruction Educator’s Golden Triangle Instruction Objectives Evaluation Outcomes

18. Reach the Golden Triangle Through Curriculum Design

19. Philosophy Outcomes Objectives Instructional Methods Evaluation Tools

20. Definition Critical Thinking The process of analyzing and understanding how and why we reached a certain conclusion.

21. Paul Bloom The Big Cheese The Teacher’s Pet Critical Thinking Test Items

22. Bloom‘s Taxonomy: Benjamin 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

23. Bloom’s Taxonomy Revised Terms 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)

24. Richard Paul: “The art of thinking about your thinking while you are thinking in order to make your thinking better: More Clear More Accurate More Defensible.”

25. Post AnalysisRELIABILITY Helps to determine the quality of a test

26. Reliability Consistency of Scores: Determines the Quality of the Test 26

27. Reliability Tools • Kuder-Richardson Formula 20 (KR20)—EXAM • Range from –1 to + 1 • Point Biserial Correlation Coefficient (PBCC)—TEST ITEMS • Range from – 1 to + 1 27

28. Standards of Acceptance • Item difficulty 30% - 90% • Item Discrimination Ratio 25% and Above • PBCC 0.15 and Above • KR20 0.60 and Above 28

29. 3-Step Method for 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 29

30. Content Validity Does the test measure what it claims to measure?

31. Content Validity • Test Blueprint • Rational/Logical Pre-Assessment Tool • Database Programs • Storage of item discrimination data

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35. Critical Thinking Test Items • 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

36. Written at the Application Level and Above • Prepare students for NCLEX • Promote thinking about clinical problems • Cause teaching methods to become creative 36

37. CriticalThinking 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? 37

38. Housekeeping Tips 38

39. Item Writing Rules • 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 39

40. … and More Rules • Use a question format when possible • Make distracters plausible and homogeneous • Equal in length • No opposites 40

41. Test Item Rationales Test Review • Learning Experience • Faculty Friendly • Legally Defensible 41

42. … and More Rules • 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

43. … and the MOST IMPORTANT Rule Develop written testing policy • Writing style • Format 43

44. 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 44

45. 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 45

46. Rationale • 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

47. i-clicker Question Which element of a Critical Thinking Test Item do you feel is the most challenging to develop? • Stem • Responses • Rationale

48. Alternate Format Questions 48

49. Alternate Test Item Format 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

50. Hot Spot 50