The document discusses methods for assessing higher-level learning in nursing students. It describes assessing application, analysis, synthesis, and evaluation through context-dependent items that require students to apply knowledge in new situations, similar to clinical practice. Examples of context-dependent items include case studies, unfolding cases, and items based on diagrams or clinical situations. Other suggested assessment methods are debates, discussions, and short writing assignments to evaluate critical thinking and clinical reasoning.

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Chapter 7
Assessment of Higher Level
Learning
&Oermann Gaberson
Evaluation and Testing in Nursing Education
4th edition

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Higher Level Thinking
♦ Application, analysis, synthesis, and
evaluation levels of cognitive taxonomy
– Apply concepts, theories, and other types of
knowledge to new situations
– Process knowledge, compare approaches
– Use knowledge to interpret patient needs
– Make decisions about actions to take
♦ Use clinical reasoning, clinical judgment
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Assessing Higher Level Learning
♦ Main principle
– Develop assessment methods that require
students to apply knowledge and skills in new
contexts
♦ Clinical practice requires higher-level thinking
– Patient needs rarely match textbook picture
– Rapidly changing conditions
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Problem Solving
♦ Ability to solve patient- and setting-related problems
is essential in clinical practice
♦ Involves:
– Recognizing and defining the problem
– Gathering additional data to clarify it further
– Developing solutions and evaluating their
effectiveness
♦ Requires understanding of the problem and possible
solutions
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Problem Solving
♦ Ability influenced by:
– Past experience with similar problems
(real or hypothetical)
• Experienced nurse can anticipate typical problems in
clinical situations
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Types of Problems
♦ Well structured
– Provide the information to solve the problem
– Typically have one correct solution
– Do not require extensive thinking skills
♦ Ill structured
– Real-life problems and clinical situations
– Problem may be unclear or there may be
insufficient data to determine the problem
– Different problems and solutions may be possible
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Decision Making
♦ Learner makes decision after considering
alternatives and their consequences
♦ Decision reflects a choice after considering
different possibilities
♦ Critical thinking helps students compare
alternatives and decide what actions to take
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Critical Thinking
♦ Reflective thinking
♦ Logical reasoning
– Thinking through and analyzing situations
– Reflecting on ideas, actions, and decisions
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Learners Who Think Critically
♦ Ask questions
♦ Are inquisitive and willing to search for
answers
♦ Consider alternate ways of viewing information
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Learners Who Think
Critically (cont’d)
♦ Offer different perspectives
♦ Extend their thinking beyond class, readings,
clinical activities, and other requirements
♦ Are open-minded
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Context-Dependent Items
♦ Learner analyzes or interprets introductory
material and answers questions or completes
other tasks related to it
♦ Also known as interpretive exercises
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Context-Dependent Items (cont’d)
♦ Can be included on NCLEX® as alternate-
format items
– Hot-spot
– Chart/exhibit
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Example—Hot-Spot Item
In this fetal monitoring strip, identify the
beginning of the contraction.
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Context-Dependent Items
♦ Advantages
– Assess student understanding of situations
simulating clinical practice
– Provide same context for analysis for all students
– Evaluate understanding, not memorization
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Context-Dependent Items (cont’d)
♦ Disadvantages
– Difficult to construct to focus on high-level
learning
– Responses may depend on reading and
writing skills
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Context-Dependent Items (cont’d)
♦ Introductory material
– Description of clinical situation
– Patient data
– Research findings
– Issues associated with clinical practice
– Excerpts from reading materials
– Diagram
– Images
– Table
– Figure
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Example—Clinical Situation as
Context
You call the pharmacy about a medication and learn
that the amount ordered is twice the usual dose. You
contact the physician who tells you, “Give it anyway.
The patient needs it.”
1.What are your options at this time? Describe
advantages and disadvantages of each.
2. How would you solve this dilemma?
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Example—Diagram as Context
Identify the corresponding structures of the nephron and state one
function for each.
30.___________________________
31.___________________________
32.___________________________
33.___________________________
34. ___________________________
For items 30-34, use the diagram below. Each response is worth
two points.
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Writing Context-Dependent Items
♦ Specify in advance:
– How responses are to be scored
– If restricted essay, limit of response length
– Criteria for evaluation
♦ Can be developed with varied types of test
items
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Layout
♦ Heading
– Indicates which items pertain to the
introductory material
♦ Context
– Needs to be obvious to students—center, extra
space before and after
♦ Test items
– On same page as heading and context if possible
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Other Assessment Methods
♦ Ask students about alternate perspectives
and options
♦ Include higher level questions
♦ Assess clinical judgment, ability to think
through situations
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Case Method
♦ Short cases
♦ Combined with higher-level questions for
assessment
♦ Any item format
♦ Appropriate for small-group analysis and
discussion
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Example
A patient is admitted with headache, nausea, and
vomiting. Two hours after admission, she complains that
her headache is getting worse, and she is “having
trouble seeing.”
1.Analyze this case in terms of content presented today
in class.
2.What data are most important and why?
3.How does this compare with Chapter 7 in your book?
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Example
You are discharging a 7-year-old child who had been
admitted following an asthma attack. In talking with
the mother, you learn that the child has been seen in
the ED at your hospital and elsewhere nearly monthly
for the last year.
1.What are two different actions you could take at this
time?
2.Which of these would you do and why?
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Example
You have your first clinical experience in a long-term
care setting and see the nursing assistant tie patients to
their chairs prior to dinner.
1.What would you do? Why?
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Example
A 12-year-old comes to the pediatrician for his allergy
injection. The mother says that her child had a fever
yesterday but is fine now. The RN gives the injection.
1.Was this the correct decision? Why or why not?
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Case Study
♦ Hypothetical or real-life situation for student
analysis
♦ Longer and more comprehensive than case
method
♦ Students include rationale underlying analysis
and decisions made
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Unfolding Cases
♦ Simulates a patient situation that changes
over time
♦ Context is presented sequentially as time
passes
– Similar to actual clinical practice
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Unfolding Cases (cont’d)
♦ Minimum of 3 brief paragraphs
– Paragraph 1 introduces case, background
information
• Follow with questions to answer
– May be discussed in small groups, reported to entire group
– Paragraphs 2 and 3 change scenario
• e.g., change in patient status, new data, new time
frame, etc.
• Follow with questions
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Example
You are making a home visit to see a 71-year-old
woman who has a leg ulcer that began after she fell.
The patient is coughing and wheezing; she tells you she
feels “terrible.”
1.What additional data would you collect in the initial
assessment? Why?
2.What actions would you take during this home visit?
Provide a rationale.
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Case continues…
In 3 days you visit this patient again. She has increased
shortness of breath, more fatigue, and a pale color.
1.Does this new information change your impression of
her problems? Why or why not?
2.List priority problems for this patient with a brief
rationale.
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Case continues…
The patient recovers from that episode, and you are
able to visit her one more time. At this last visit, she is
still short of breath but otherwise seems improved.
1.Write your final report on this patient using the form
of the home care agency.
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Discussion
♦ Focus on higher-level questions
– Begin with lower level (factual questions) and
progress to higher level questions
♦ Phrase questions carefully to encourage
students to think through answer
♦ Individual or small group
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Debate
♦ Use for assessing ability to
– analyze problems
– consider alternative points of view
– develop position
♦ Use for assessing critical thinking
♦ Evaluate based on strength of argument
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Media Clips
♦ Short media clips for analysis
♦ Timing of use
– Intersperse within class or online presentation
– Use at end for synthesis
♦ Case method presented visually
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Short Written Assignments
♦ Assess students’ thinking and reasoning
♦ Avoid summarizing literature and reporting
on ideas of others
♦ Conserve faculty time
♦ Give prompt feedback
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