What to Expect
In previous courses, you learned how to reach out to diverse audiences by using learner-centered
teaching strategies. This course will build on that learning by helping you identify techniques to
effectively measure the success of various learning outcomes. This course will equip you with
skills necessary for writing, administering, and scoring tests.
Even though the ability to measure learning outcomes is one of the many competencies expected
of a nurse educator, it is an area that most nurse educators seldom explore. Almost all nurse
educators have their own beliefs, which guide their evaluation process. This fiveweek course will
help you understand test evaluation and develop your own philosophy concerning it. This course
will acquaint you with the different types of test items that can be used in nursing. At the end of
five weeks, you will be able to design evaluations for use in both clinical and academic settings.
Learning objectives and test items differ according to the settings in which they are administered.
Throughout this course, you will learn to design test items to measure learning outcomes in
varied settings. The readings and assignments in this course further develop your understanding
of the subject.
The Test Development Exercises and Evaluation Project will help you apply what you have
learned in the course. You will create a test blueprint, design different types of test items,
measure the reliability and validity of these test items, and then apply the statistical analysis for
these items. For each week, you will be required to respond to the related activities. As you
progress through this course, the assignments will give you an insight into the issues that impact
Summary: The ability to measure learning outcomes is one of the many competencies expected
of the nurse educator. This will be acquainted with the different types of testing modalities that
can be used in different nursing practice settings. The test development exercises and evaluation
project will help you apply what you have learned and understand test evaluation to develop your
own philosophy towards evaluation of educational outcomes in nursing education.
Importance of Tests
Testing allows nurse educators to measure learning using both formative and summative
In formative evaluation, a student’s performance and learning is monitored and documented on a
regular basis. Students are given timely feedback by the educators for the purpose of improving
their performance. These records are compiled at the end of a program in a summative evaluation
report. Summative evaluation measures overall learning in terms of scores and grades at the end
of a course or program.
Different types of tests are used to determine learning in different domains of knowledge. For
example, an objective test is an appropriate measure of didactic instruction where content is
delivered in lecture format. Objective tests can be used to evaluate the critical thinking process of
learners. For example, you can develop a multiple choice question test listing methods of
performing CPR on infants. Here, all the options should be plausible and the learner should think
and choose the most appropriate answer. Return demonstration is a performance-based test used
to evaluate psychomotor skills in nursing professionals. For example, it can be used to assess a
learner’s ability to actually perform a skill such as CPR on infants.
Not all learners will respond well to the same testing methods.This is because of differences in
individual learning styles. As a nurse educator, you should be aware of different approaches for
evaluating learning outcomes. These approaches include tests, return demonstrations, direct
observations, verbal interactions, attitudinal surveys, and expository writing.
In classes, nursing students learn about theoretical aspects of nursing care. In the health care
facility, they have the opportunity to apply their knowledge and skills in clinical situations. In a
community setting, nursing professionals are responsible for educating community members and
meeting the critical health care needs of the communities.
Selecting Appropriate Tests
Each learning situation needs a different type of evaluation to maximize the effectiveness of
assessment. For example, a written exam is inappropriate for a clinical setting because the
learning evaluation should focus on psychomotor skills. Instead, the nurse educator should
observe the learner practicing and communicating with patients to assess his or her performance.
Accordingly, in a clinical setting, you can use checklists and evaluation forms to evaluate
learner-patient interaction and psychomotor skills.
Similarly, in a class of 50 students, a skills demonstration or verbal examination may be too
time-consuming to be practical. Also, such evaluation runs the risk of violating federal
legislation regarding student privacy. For hospital based staff education, performance-based
evaluation maybe the best mode of assessment while in academic setting written tests are
In academia, objective tests are considered effective means of evaluating learner outcomes.
Objective tests are easy to administer and grade, often using the help of computer based tests.
Additionally, interactive CD-ROMs and other technological media can aid in evaluations. Some
other possible means of evaluating learner outcomes include written papers, student
presentations, and gaming.
Simulation-based gaming and role playing are different forms of gaming used for evaluation. In
simulation-based gaming and role playing, learners are assigned a critical role and asked to
respond to certain medical conditions in a simulated environment that requires decision making
and critical thinking.
In a community setting, learning outcomes are rarely evaluated because testing often makes adult
learners anxious. Instead, learning is evaluated by encouraging learners to ask questions and
Consider this example. You are conducting a session on the self-management of pain in older
adults. After you finish delivering the lecture, you can assess the audience’s level of
understanding by asking them questions and/or asking if anyone has questions for content
clarification. This strategy can help to gauge audience understating, answer questions, and
Apart from the setting, there are several other factors that should be considered when selecting
the most appropriate evaluation method. You will learn about these factors in the following
Additional Selection Factors
A successful test accurately measures the attainment of learning outcomes based on some predetermined criteria.
Guidelines are given below for selecting a test item:
Is the test environment conducive to the form of testing selected? For example, is there sufficient
room for students to be appropriately spaced during a written exam? For a clinical skills
examination in a learning laboratory, are there sufficient supplies and nurse educators to evaluate
the number of students being tested?
Does the test cover the material that the learner is expected to study? Sometimes educators use
questions from test banks, specific to a course text for assessment. Before administering such
tests, they should verify that the questions actually test the learners in what they are expected to
study. For example, if you are providing an examination on the endocrine system, it would be
inappropriate to include questions about psychiatric or mental health nursing unless those areas
being asked are related to the endocrine system.
Is the time provided to answer a test adequate? For example, is it fair to expect learners to
answer a hundred objective questions in an hour? A 50 item multiple-choice test should take
about 60 minutes, which would give approximately 1.2 minutes per question. Sixty minutes
would allow for 75–80 T/F items, which would give approximately 0.75 seconds per question.
Depending on the format of the essay questions (short answer vs. long answer), it could be 15
minutes for one short answer or 30 minutes for one long answer question on a 60-minute test.
Is the test reliable, valid, and internally consistent? You may or may not always be responsible for
evaluating learning outcomes. For example, in academia, a nurse educator is expected to evaluate
whether or not students have achieved program outcomes. In a clinical setting, the nurse educator
may only be responsible for providing instruction, while the unit manager may be the one who
evaluates if learning outcomes were met by observing actual employee performance. These data
sources are then compiled and compared to ascertain whether or not educational offerings have
met the objectives of instruction.
Fundamentals of Assessment
The manner in which test items are designed reflects the emphasis that a nurse educator and
course place on various components of the curriculum. Test items should be designed in such a
way that they assess various domains of learning.
Your choice of test items should depend on the nature of the content, skills, and competencies
being assessed. The appropriateness of a particular test item depends on:
The learning domain (cogitative, affective, and psychomotor) being examined. Whether test is
assessing the knowledge of the learning domain or a skill needed for the learning domain.
The level of learning according to Bloom’s Taxonomy being tested
Prior knowledge the learner possesses
For example, the way testing is approached is very different in clinical settings than on online
graduate nursing courses. In the first example, learners can be observed or demonstrate various
clinical procedures to gauge their competence in a particular area of a course.
In an online graduate classroom, however, you would not be expected to assess clinical
procedures since BSN and graduate level nurses already hold RN licenses and are trying to
acquire additional academic knowledge. In this example, you will rely on learner participation in
discussion threads, written papers, and group work to evaluate the students’ understanding of
Example: Determining Appropriateness
The following example will help you understand how to determine if test questions are
appropriate with respect to content and competency.
You are attempting to determine the ability of an undergraduate nursing student to prioritize
nursing care. To do this, you present the students with a scenario describing the patients to be
cared for. Then, you ask the students to list the order in which they would provide care to these
patients. This enables you to evaluate the student’s critical-thinking abilities as related to
prioritizing patient needs.
Here is a list of test items that you can use in academics and clinical settings.
Types of test items used in academia:
Short answer exams
Types of test items used in a clinical setting:
Clinical evaluation forms
Some evaluation strategies that are used in community settings are:
Question and answer sessions
Post-course evaluation in which the learner is asked to evaluate how well objectives were met
Keep in mind these basics as you begin designing a comprehensive test.
In online evaluation, however, you cannot use hands-on and return demonstration due to lack of
face-to-face interaction. For online evaluation, you can use objective test items, essay test items,
paper presentation, PowerPoint presentations, and portfolio evaluation.
Comprehensive Test Development
Comprehensive test development involves aligning test items to course objectives. Before
designing a test, you must first decide which learning outcomes you want to evaluate. You
already know that good content is the basic requirement for designing a good test. Begin by
considering course objectives. Ask yourself: What should the learner be able to do after
completing this course? As a nurse educator, you should consider the objectives from each
lesson plan and decide the level of competence that you expect from your learners. Each test
item should then be developed to measure the appropriate level of knowledge.
For example, if you want your learner to know the definition of a term, you should not assess the
learner for application of that knowledge on the test. Your test items should evaluate the learner
at the same level of knowledge that is stated in the objectives.
Once you have aligned test items to learning outcomes, you need to look into the presentation
format of the test items. Readability and proper grouping of test items directly impact the
presentation. Readability is the reading ease, the quality of your language, and the level of
reading comprehension of yourstudents. Good readability ensures that your students are able,
process the words they are seeing, and then understand its meaning. You do not want your font
size too big or too small and you should avoid font styles that are fancy, or decorative.To assure
readability of the test, you should have another faculty member review your test.
Test items can be grouped according to the format of the questions. Group similar item types of
questions together (e.g., all multiple-choice items, T/F, matching, essay, etc.). Place items within
each group in ascending order of difficulty and begin the test with an easy question to lesson test
anxiety. Since exams are meant to test learning, you should maximize the student’s ability to
provide proof of learning
Another point to consider when designing tests is that you should ensure that all learners have a
fair chance of passing each test. This means that test items should be developed with the
intellectual abilities of all learners in mind. Tests should have a proper balance of easy, average,
and difficult items. To develop a comprehensive test you need to have a blueprint that helps the
educator look at the goals and objectives of the test, and assign proper weightage to the various
skills and competencies to be evaluated.
A test blueprint is nothing more than a chart that lists the specifications of a test. It helps
determine what percentage ofthe test should be devoted to each content area. It also specifies the
percentage of cognitive domains for a given content area. A blueprint demonstrates the level of
cognitive processing expected of the examinees while responding to specific test items. A
blueprint provides clear direction to build the test. Tests constructed without this type of
blueprint often result in certain objectives being over-represented and other objectives underrepresented. Once you have the blueprint the next step is to write the test items. The test requires
complex cognitive processing and to apply critical thinking skills to solve problems.
A typical test blueprint is a two-way matrix that has content areas in rows and cognitive domains
in columns. The blueprint is a guide to writing tests and brings in an element of consistency
across the test items. The test blueprint identifies the objectives to be tested and the relative
weight (formula and percentages) on the test given to each question and objective. The formula
stipulates how many questions are to be constructed in the cognitive domain of Bloom’s
Taxonomy and the percentage is the number (amount) of questions that will test the objective or
Educators sometimes design a test without considering if the test assesses the different levels of
the cognitive domain. For example, one common problem with multiple-choice items is testing
only knowledge and comprehension. In such cases, you should select different kinds of test items
which will also assess application, analysis, and synthesis.
Using the blueprint ensures that all content areas are covered in appropriate levels of difficulty
and takes into accountappropriate cognitive levels. To develop a test blueprint, select a content
area, decide on the cognitive level for assessing that content, and choose the type of test item.
The blueprint is aguide for developing exam questions, list specific outcomes or objectives to be
tested, list specific content, and concepts or behaviors using Bloom's taxonomy behavioral verbs
in the cognitive domain.
Take a look at the steps of creating a test blueprint:
Delineate the content areas.
Determine what percent of the test should be devoted to each content area.
Determine at what cognitive levels you want to test that area, and what percent of that content
area should be tested at that level.
Enter the percentages and make sure that your final figure equals 100%
The novice nurse educator may not understand the usefulness of the test blueprint and think of it
as a “paper exercise.” Many accrediting agencies such as the National\ League for Nursing
(2013) and the Collegiate Commission on Nursing Education (2014), prefer to see that faculty
have given evaluation a level of consideration that was deliberate, methodical, and
One common error is in the mathematics of the blueprint. You must begin by looking at what
percentage of the course content applies to each of the objectives for the content of the test. Once
you have determined this, you can then calculate, based on the total number of test questions,
how many questions each content area and each domain level will need. Check that each
calculated percentage for each domain totals 100%.
Next, choose how many items will be on the exam, which may include multiple-choice, T/F,
essay, and alternate item format questions.
Then choose the testing allotted time based on the amount of time it takes to answer each
question. A 50-item multiplechoice test should take about 60 minutes, which would give
approximately 1.2 minutes per question. Sixty minutes would allow for 75–80 T/F items, which
would give approximately 0.75 seconds per question. Depending on the format of the essay
questions (short answer vs. long answer), it could be 15 minutes for one short answer or 30
minutes for one long answer question on a 60 minutes test).
Summary: Evaluation uses both formative and summative methods to measure learning. A
successful test is one that measures learning based on a pre-determined learning evaluation plan.
In the community setting, the use of evaluation tools is limited because many adults have
negative attitudes toward tests and may be limited by language barriers. Nurse educators should
help create a learning environment, which is “non-threatening” to the adult learner by omitting
formal written tests in the community setting. Comprehensive test development requires the
alignment of test items with course objectives. Readability and proper grouping of test items are
essential to ensure that items are presented logically and systematically. The same testing
methods should be grouped together; however, the content should be arranged throughout the
test so cuing does not occur. The blueprint is a guide to writing tests and brings in an element of
consistency across the test items A test blueprint determines what percentage of content area a
test consists of and, under each content area, what percentage of each level of the cognitive
domain of learning makes up a given content area to be utilized on the test.
Collegiate Commission on Nursing Education. (2014).CCNEaccreditation. Retrieved from
http://www.aacn.nche.edu/ccneaccreditation Accreditation Commission for Educaton in Nursing
(ACEN). (2013). Accreditation manual. Retrieved from
National Patient Safety Goals
In 2002, The Joint Commission established its National Patient Safety Goals (NPSGs) program;
the first set of NPSGs w ...
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