Assessment of Higher Level Learning: Context Dependent Item Sets and other Assessment Methods

Context Dependent Item Sets and other Assessment Methods

In preparing students to meet the needs of patients within the changing health care system, educators are faced with identifying essential content to teach in the nursing program. Mastery of this knowledge alone, however, is not enough.

Students also need to develop cognitive skills for processing and analyzing information, comparing different approaches, weighing alternatives, and arriving at sound conclusions and decisions. These cognitive skills include, among others, the ability to apply concepts and theories to new situations, problem solving, and critical thinking.

Higher Level Learning

Learning extends from simple recall and comprehension, which are lower level cognitive behaviors, to higher level thinking skills. Higher level cognitive skills include application, analysis, synthesis, and evaluation. With higher level thinking, students apply concepts, theories, and other forms of knowledge to new situations, use that knowledge to solve patient and other types of problems, and arrive at rational and well thought-out decisions about actions to take.

The main principle in assessing higher level learning is to develop test items and other assessment methods that require students to apply knowledge and skills in a new situation ( Nitko & Brookhart, 2007). Only then can the teacher assess whether the students are able to use what they have learned in a different context.

Considering that patients and treatments often do not match the textbook descriptions, and health status can change quickly, students need to develop their ability to think through clinical situations and arrive at the best possible decisions. By introducing novel materials into the evaluation process, the teacher can assess whether the students have developed these cognitive skills.

Problem Solving

In the practice setting, students are continually faced with patient problems and other problems to be solved. Some of these problems relate to managing patient conditions and deciding what actions to take, whereas others involve problems associated with the nurse’s role and work environment. The ability to solve patient and setting-related problems is an essential skill to be developed and evaluated.

Problem solving begins with recognizing and defining the problem, gathering data to clarify it further, developing solutions, and evaluating their effectiveness. Knowledge about the problem and potential solutions influences the problem-solving process. Students faced with patient problems for which they lack understanding and a relevant knowledge base will be impeded in their thinking.

This is an important point in both teaching and assessing problem solving. When students have an understanding of the problem and possible solutions, they can apply this knowledge and expertise to new situations they encounter in the clinical setting. Past experience with similar problems, either real problems in the clinical setting or hypothetical ones used in teaching, also influences students’ skill in problem solving.

Experience with similar problems gives the student a perspective on what to expect in the clinical situation typical problems the patient may experience and approaches that are usually effective for those problems. Expert nurses and beginners, such as students, approach patient problems differently (Benner, 2001).

As a result of their extensive clinical experience, experts view the clinical situation as a whole and use their past experience with similar patients as a framework for approaching new problems. Cognitive Development Problem-solving skill is influenced in general by the student’s level of cognitive development. Perry’s (1981, 1999) theory of cognitive development suggests that students’ cognitive ability progresses through these four stages:

■ Dualism: In this first stage, students view knowledge and values as absolutes. In terms of problem solving, they look for one problem with accepted solutions from their readings and prior learning. At this stage, students do not consider the possibility of different problems and varied solutions to them.

■ Multiplicity: In the second stage, students are willing to acknowledge that the problems may be different from the first ones identified and that varied solutions may be possible. They begin to accept the notion that multiple points of view are possible in a given situation. In this stage, learners are able to see shades of gray rather than only “black and white.”

■ Relativism: In the third stage, relativism, students possess the cognitive ability and willingness to evaluate different points of view. At this stage in their cognitive development, students have progressed in their thinking so they can evaluate varying perspectives and approaches relative to one another.

■ Commitment in Relativism: Perry’s final stage of cognitive development reflects a commitment to identify one’s values and beliefs and to act on them in practice. Perry’s original studies were done with male students attending Harvard, and although further work by other researchers has expanded the sample, more study is indicated.

Even so, this theory provides a way to view the development of cognitive skills among nursing students. Skill in problem solving and critical thinking may reflect the student’s stage of cognitive development. Complexity of thinking and problem solving, acceptance of multiple perspectives, and ability to deal with ambiguity, all of which are important in critical thinking, occur at later stages of cognitive development.

Well-Structured and Ill-Structured

Problems Nitko and Brookhart (2007) defined two types of problems that students may be asked to solve: well-structured and ill structured. Well-structured problems provide the information needed for problem solving; Typically, they have one correct solution rather than multiple ones to consider and in general are “clearly laid out” (p. 216).

These are problems and solutions that the teacher may have presented in class and then asked students about in an evaluation. Well-structured problems provide practice in applying concepts and theories learned in class to hypothetical situations but do not require extensive thinking skills. In contrast, ill-structured problems reflect real-life problems and clinical situations faced by students. Ill-structured problems are authentic ( Nitko & Brookhart, 2007).

With these situations, the problem may not be clear to the learner, the data may suggest a variety of problems, or there may be an incomplete data set to determine the problem. Along similar lines, the student may identify the problem but be unsure of the approaches to take; multiple solutions may also be possible. Some assessment methods for problem solving address well-structured problems, assessing understanding of typical problems and solutions.

Other methods assess students’ ability to analyze situations to identify different problems possible given the data, identify additional data needed to decide on a particular problem, compare and evaluate multiple approaches, and arrive at an informed decision as to actions to take in the situation.

Decision Making

Nurses continually make decisions about patient care decisions about problems, solutions, other approaches that might be possible, and the best approach to use in a particular situation. Other decisions are needed for delivering care, managing the clinical environment, and carrying out other activities. In decision making, the learner arrives at a decision after considering a number of alternatives and weighing the consequences of each.

The decision reflects a choice made after considering these different possibilities. In making this choice, the student collects and analyzes information relevant to identifying the problem and making a decision, compares the decisions possible in that situation, and then decides on the best strategy or approach to use. Critical thinking helps students compare alternatives and decide what actions to take.

Critical Thinking

There has been extensive literature in nursing over the last decade about the importance of students developing the ability to think critically. The complexity of patient, family, and community needs; the amount of information the nurse needs to process in the practice setting; the types of decisions required for care and supervision of others in the delivery of care; and multiple ethical issues faced by the nurse require the ability to think critically.

Critical thinking is needed to make reasoned and informed judgments in the practice setting; By using critical thinking, the nurse decides what to do or believe in a given situation. Critical thinking is particularly important when problems are unclear and have more than one possible solution.

Ennis (1985) provided an early definition of critical thinking that remains valid today. I have defined critical thinking as reflective and reasoned thinking that focuses on deciding what actions to take and what to believe in a situation. There are eight elements of reasoning to be considered in the process of critical thinking:

1. Purpose the thinking is to serve
2. Questions to be answered
3. Assumptions on which thinking is based
4. Analysis of one’s own point of view and those of others
5. Data, information, and evidence on which to base reasoning
6. Key concepts and theories for use in thinking
7. Inferences and conclusions possible given the data, and
8. Implications and consequences of reasoning (Paul, 2003, 2005; Paul & Elder, 2003).

In the clinical setting, critical thinking enables the student to arrive at sound and rational judgments to carry out patient care. Carrying out assessment; planning care; intervening with patients, families, and communities; and evaluating the effectiveness of interventions all these require critical thinking.

In the assessment process, important cognitive skills include differentiating relevant from irrelevant data, identifying cues in the data and clustering them, identifying additional data to collect prior to arriving at decisions about the problem, and specifying patient problems based on these data.

Critical thinking is also reflected in the ability to compare different possible approaches, considering the consequences of each, to arrive at a decision on the nursing measures and approaches to use in a particular situation (Alfaro-LeFevre, 2004; Oermann, 1997, 1998, 2000); Judgments about the quality and effectiveness of care are influenced by the learner’s thinking skills.

Facione and Facione (2008) indicated that even expert clinicians are never beyond the need to reflect on their clinical reasoning and to continue to build their critical thinking skills. Students who demonstrate critical thinking ability:

■ ask questions, are inquisitive, and willing to search for answers;

■ consider alternate ways of viewing information;

■ offer different perspectives to problems and solutions;

■ question current practices and express their own ideas about care;

■ extend their thinking beyond the readings, class instruction, clinical activities, and other requirements; and

■ are open-minded.

These characteristics are important because they suggest behaviors that are to be developed by students as they progress through the nursing program. They also provide a framework for faculty to use when assessing whether students have developed their critical thinking abilities.

Context-Dependent Item Sets

In assessing students’ cognitive skills, the test items and other methods need to meet two criteria. They should

(a) Introduce new information not encountered by students at an earlier point in the instruction and

(b) Provide data on the thought process used by students to arrive at an answer, rather than revealing the answer alone.

Context-dependent item sets may be used for this purpose. Other assessment methods include case method, case study, and unfolding case; discussion; debate; media clips; short written assignments; and varied clinical evaluation methods.

Writing Context-Dependent Item Sets

A basic principle of assessing higher level skills is that the test item or other assessment method has to introduce new or novel material for analysis. Without the introduction of new material as part of the assessment, students may rely on memorization from prior discussion or their readings about how to solve problems and arrive at decisions for the situation at hand; they may simply recall the typical problems and solutions without thinking through other possibilities themselves.

In nursing education this principle is usually implemented through clinical scenarios that present a novel situation for students to analyze. Nitko and Brookhart (2007) referred to these items as context-dependent item sets or interpretive exercises. In a context-dependent item set, the teacher presents introductory material that students then analyze and answer questions about.

The introductory material may be a description of a clinical situation, patient data, research findings; issues associated with clinical practice, and varied types of scenarios. The introductory material may also include diagrams, photographs, tables, figures, and excerpts from reading materials. Students read, analyze, and interpret the introductory material and then answer questions about it or complete other tasks.

One advantage of a context-dependent item set is the opportunity to present new information for student analysis that is geared toward clinical practice. In addition, the introductory material provides the same context for analysis for all students. The questions asked about the introductory material may be selected or constructed-response items.

With selected-response items such as multiple-choice, however, the teacher is not able to assess the underlying thought process used by students in arriving at the answer; their responses reflect instead the outcomes of their thinking. If the intent is also to assess the thought process, then open-ended items such as short answer and essay should be used.

Interpretive Items on the NCLEX

On the NCLEX Examination, candidates may be asked to interpret tables, figures, graphs, diagrams, and images, and to respond to questions about them using the standard multiple-choice format or alternate item formats (National Council of State Boards of Nursing, 2006, 2007). Alternate formats include multiple-response, fill-in-the-blank, hot-spot, chart/exhibit, and drag-and-drop items.

In a hot-spot item, candidates are asked a question about an image; They answer the question by clicking on the image with their mouse. In chart/exhibit items, candidates are given a problem, and to answer that problem, they need to read and interpret information in a chart or an exhibit. Chart/exhibit items on the NCLEX  are set up with tabs; each tab presents information related to the problem, similar to a patient’s medical record.

Students should have experience answering these types of questions and other forms of context-dependent items as they progress through a nursing program. Items can be incorporated into quizzes and tests; can be developed for small-group analysis and discussion in class, as out-of-class assignments, and as online activities; and can be analyzed and discussed by students in post clinical conferences.

Layout

The layout of the context-dependent item set, that is, the way it is arranged on the page, is important so that it is clear to the students which questions relate to the introductory material. Exhibit 7.2 illustrates one way of arranging the material and related items on a page.

A heading should be used to indicate the items that pertain to the introductory material, for example, “Questions 1 through 3 refer to the scenario below.” Nitko and Brookhart (2007) suggested that the material for interpretation be placed in the center of the page so that it is readily apparent to the students. If possible, the context and all items pertaining to it should be placed on the same page.

Strategies for Writing Context-Dependent Items

Suggestions follow for writing context-dependent item sets. However, the scenarios and other types of introductory material for analysis may be presented through multimedia and other types of instructional technology. If the intent is to assess students’ skills in problem solving and critical thinking, the introductory material needs to provide sufficient information for analysis without directing the students’ thinking in a particular direction.

The first step is to draft the types of questions to be asked about the situation, then to develop a scenario to provide essential information for analysis. If the scenario is designed on the basic of clinical practice, students may be asked to analyze data, identify patient problems, decide on nursing interventions, evaluate outcomes of care, and examine ethical issues, among other tasks.  The introductory material should be geared to the students’ level of understanding and experience.

The teacher should check the terminology used, particularly with beginning students. The situation should be of reasonable length without extending the students’ reading time unnecessarily. The questions should focus on the underlying thought process used to arrive at an answer, not on the answer alone. In some situations, however, the goal may be to assess students’ ability to apply principles or procedures learned in class without any original thinking about them.

In these instances, well-structured problems with one correct answer and situations that are clearly laid out for students are appropriate. The teacher should also specify how the responses will be scored, if the responses are restricted in some way, such as by page length, and the criteria used for evaluation.

Context-dependent items may be incorporated within a test, completed individually or in small groups for formative evaluation, discussed in class for instructional purposes, completed during post clinical conferences, or done as out-of-class assignments, either graded or ungraded. If group work is evaluated for summative purposes, students should have an opportunity to evaluate each other’s participation. Item sets focusing on assessment of problem-solving ability may ask students to complete the following tasks:

■ Identify the problem and alternate problems possible

■ Develop questions for clarifying the problem further

■ Identify assumptions made about the problem and solutions

■ Identify additional data needed for decision making

■ Differentiate relevant and irrelevant information in the situation

■ Propose solutions, possible alternatives, advantages and disadvantages of each, and their choices

■ Identify obstacles to solving a problem

■ Relate information from different sources to the problem to be solved

■ Evaluate the effectiveness of solutions and approaches to solving problems and the outcomes achieved the following item set assesses students’ skill in problem solving.

After reading the introductory situation about the patient, students are asked to identify all possible problems and provide data to support them. Other questions ask students about additional data to be collected, again with a rationale for their answer Your 8-year-old patient had a closed head injury 4 weeks ago after falling off his bike.

You visit him at home and find that he has weakness of his left leg. His mother reports that he is “getting his rest” and “sleeping a lot.” The patient seems irritable during your visit. When you ask him how he is feeling, he tells you, “My head hurts where I hit it.” The mother appears anxious, talking rapidly and changing position frequently.

1. List all possible problems in this situation. For each problem describes supporting assessment data.
2. What additional data are needed, if any, to decide on these problems? Provide a rationale for collecting this information.
3. What other assessment data would you collect at this time? Why is this information important to your decision making?

Context-dependent items may focus on actions to be taken in a situation. For this purpose, the teacher should briefly describe a critical event, and then ask learners what they would do next. Because the rationale underlying the thinking is as important as if not more important than the decision or outcome, students should also include an explanation of the thought process they used in their decision making.

For example: You are a new employee in a nursing home. At mealtime you find the patients sitting in chairs with their arms tied to the sides of the chair.

1. What would you do?
2. Why did you choose this action?

If the goal is to assess students’ ability to think through different decisions possible in a situation, two approaches may be used with the item set. The introductory material

(a) may present a situation up to the point of a decision, and then ask students to make a decision or

(b) May describes a situation and decision and ask whether they agree or disagree with it. For both of these approaches, the students need to provide a rationale for their responses.

Examples of these strategies follow. Your nurse manager on a busy surgery unit asks you to cover for her while she attends a meeting. You find out later that she left the hospital to run an errand instead of attending the meeting.

1. Identify three alternate courses of action that could be taken in this situation.
2. Describe the possible consequences of each course of action.
3. What decision would you make? Why? A patient calls the office to see if he can receive his flu shot today. He had a cold a few days ago but is feeling better and has returned to work. The nurse instructs the patient to come in for his flu shot.
4. Do you agree or disagree with the nurse’s decision?
5. Why or why not? Often context-dependent item sets are developed around clinical scenarios.

However, they are also valuable techniques to assess student ability to analyze issues and describe how they would resolve them, articulate different points of view and the reasoning behind each one, evaluate evidence used to support a particular position, and draw inferences and conclusions that follow from the evidence.

Students can be given articles and other material to read and analyze, presented with graphs and tables for interpretation, and given photographs and diagrams with questions to answer. Context-dependent items provide a way for teachers to examine how well students use information and think through situations. Examples of context-dependent item sets are found in Exhibit 7.3.

Assessment Methods for Higher Level Cognitive Skills

Although context-dependent item sets provide one means of assessing higher level cognitive skills, other methods are available for this purpose. Those alternate approaches include: case method, case study, and unfolding cases; discussion; debate; media clips; short written assignments; and varied clinical evaluation methods, which will be presented.

Case Method, Case Study, and Unfolding Cases

With cases, students analyze a clinical scenario and answer related questions. The focus might be on identifying problems and possible approaches, making decisions after weighing the options, planning additional data to collect, applying concepts and theories from class and readings to the case, examining the case from different points of view, and identifying actions to take .

When used in these ways, cases are effective for developing problem-solving and critical-thinking skills (Baumberger-Henry, 2005; Gaberson & Oermann, 2007; Tomey, 2003). In the case method, the cases tend to be short, providing only essential information about the scenario, in contrast to case studies, which are longer and offer more detail.

Cases work well for group analysis and discussion, either in class as small-group activities or in post clinical conference. In groups, students can criticize each other’s’ thinking; compare different perspectives of the problem, solutions, and possible decisions; and learn how to arrive at a group consensus. Used as a small-group activity, the case method is more easily evaluated for formative than summative purposes.

Exhibit 7.4 presents examples of a case method, case study, and unfolding case. A case study provides a hypothetical or real-life situation for students to analyze and then arrive at varied decisions. Case studies are more comprehensive than the introductory material presented with the case method (Exhibit 7.4). With case studies, students are able to provide detailed and in-depth analyzes and describe the evidence on which their conclusions are based.

The case study also provides a means for students to apply relevant concepts and theories from class and from their readings. A case study may be completed as an individual assignment and evaluated similarly to other written assignments as long as the students provide a rationale for their decisions. The results of the case analysis may be presented orally for group criticism and feedback.

One other method to use to assess higher level learning is unfolding cases, which provide a means of simulating a patient situation that changes over time. Rather than writing one short case, as in a case method, or a more comprehensive one with background information, as in a case study, unfolding cases describe changes in a patient’s condition or a setting of care similar to what might occur with a current patient (Exhibit 7.4).

Feingold, Calaluce , and Kallen (2004) suggested that these clinical scenarios were valuable for developing critical thinking and problem-solving competencies. Ulrich and Glendon (1999) developed a model for writing unfolding cases, which can then be evaluated. This strategy includes at least three paragraphs for analysis and discussion by students. The case is presented in the first paragraph, followed by questions for problem solving and critical thinking.

The case unfolds as the teacher presents new information about the patient or clinical situation in a second paragraph, again accompanied by higher level questions for students to answer. By introducing new data in subsequent paragraphs, the teacher presents a changing patient scenario. In Ulrich and Glendon’s model, at the end of the unfolding case, students complete a short writing exercise to identify where further learning is needed and to reflect on the case and their responses.

Azzarello (2008) developed a rubric for evaluating the quality of the students’ analysis of an unfolding case. Students receive higher scores when they identify critical problems early in the case and request information to clarify a problem or solution.

Discussion

Discussions with students individually and in small groups are an important strategy for assessing problem solving, decision making, and critical thinking abilities. In a discussion, the teacher has an opportunity to ask questions about students’ thinking and the rationale they use for arriving at decisions and positions on issues. Discussions may be impromptu; used for formative evaluation; or structured by the teacher so as to provide a context and questions to which students respond.

Use of discussion for assessing cognitive skills, however, requires careful questioning with a focus on the critical thinking used by students to arrive at answers. In these discussions, the teacher can ask students about possible decisions, reasons underlying each decision, consequences and implications of options they consider as part of their decision making, and different points of view in the situation.

The difficulty level of questions asked is significant; one should avoid a predominance of factual questions and focus instead on clarifying and higher level questions. With factual questions, students recall facts and specific information about the problem and issue being discussed. For example, factual questions are: “What is a nursing diagnosis?” and “What are subjective data?”

Clarifying and explanatory questions require further thought and discussion. For instance, a clarifying question is: “Tell me the relationship between assessment and nursing diagnosis.” For these questions, students explain their answers using their own terminology. Higher level questions, geared toward critical thinking, cannot be answered by memory alone and require an evaluation or a judgment of the situation ( Gaerson & Oermann, 2007; Oermann, 2004).

Examples of higher level questions are: “What are similarities and differences between the assessments and diagnoses for Mrs. S and for the patient you had last week?” and “Which pain interventions would you propose for this patient? Why did you decide on these interventions rather than the others?”

Questions for discussions should be sequenced from a low to a high level, beginning with factual questions to evaluate students’ knowledge of relevant concepts and theories and their ability to apply them to the situation, problem, and issue, and progressing to questions that evaluate students ‘critical thinking. Bloom’s taxonomy can be used as a framework for developing questions for discussions focusing on higher level thinking.

With this schema, low-level questions would ask for recall of facts and comprehension. Higher level questions would focus on application, analysis, synthesis, and evaluation. Discussion of the level of questions asked by the teacher is important because research suggests that teachers by nature do not ask higher level questions of students.

Questions asked of nursing students tend to focus on recall and comprehension rather than on higher levels of thinking ( Gaberson & Oermann, 2007; Hsu, 2007; Oermann, 2008; Profetto -McGrath, Smith, Day, & Yonge, 2004).

If discussions are to be geared toward assessment of problem solving and critical thinking, the teacher needs an awareness of the level of questions asked for this purpose. When a student answers a question correctly, the teacher should explore alternate possibilities and then proceed to a higher level question. The questions presented in Exhibit 7.1 for assessing critical thinking may be used to guide discussions. In a discussion, the teacher or preceptor should ask students about:

■ questions, issues, and problems to be resolved;

■ Assumptions on which their thinking is based;

■ their own points of view and those of others;

■ The information and evidence on which they are basing their thinking;

■ Concepts and theories applicable to the question, issue, or problem being discussed;

■ Inferences and conclusions possible; and

■ Implications and consequences of their reasoning.

Socratic Method

The Socratic Method also may be used for developing questions to assess students’ critical thinking in a discussion. One of the goals of the Socratic Method is to encourage the student to form connections among ideas (Elder & Paul, 2002). There are two phases in the Socratic Method: systematic questioning and drawing comparisons. In systematic questioning, the initial phase, the teacher designs a series of questions that lead students along predetermined paths to rational thinking (Overholser, 1992).

Questions are open ended, have multiple possible responses, and ask students to defend their views and positions. With this method the teacher avoids asking questions with one correct answer. In the second phase of questioning, the teacher asks the students to draw comparisons and generalizations from the situation being analyzed to other situations.

Sedlak and Doheny (2004) suggested that Socratic questions arouse curiosity, encourage students to think on their own, and provide a logical, stepwise guide to assist students in understanding a complex topic or issue. Socratic questioning works well for formative evaluation and can be used in the classroom with the teacher leading the discussion with the class, in post clinical conferences, and in the form of written questions that students answer in small groups.

Bowles (2006) suggested preparing a set of brief statements with inaccuracies about the content students are learning in class. Students are directed to correct the statements, with the teacher discussing their responses through Socratic questioning. With a logical sequence of questions, students can analyze complex issues, examine alternate points of view, and draw generalizations across different content areas. However, these outcomes will not be achieved without carefully thought-out questions by the teacher.

Debate

Debate provides an effective mechanism for assessing students’ ability to analyze problems and issues in depth, consider alternative points of view, and formulate a position. The process of analyzing the issue for the debate, considering alternative viewpoints, developing a sound position, and preparing arguments for the position taken provides opportunities for an assessment of students’ critical thinking skills.

Bradshaw and Lowenstein (2001) also suggested that the debate itself allows students to gain experience in speaking to a group and to develop their oral communication skills. The focus in evaluating a debate should be on the strength of the argument developed and presented to the group. Areas to consider in evaluating debates include:

1. Clarity and comprehensiveness of the analysis of the issue;
2. Rationale developed for the position taken, including use of the literature and available research;
3. Consideration of alternative positions;
4. Clarity of responses to the opposing side;
5. Organization and development of the argument;
6. Degree of persuasiveness in presenting the argument; and
7. Presentation skills, including keeping the audience interested and focused, presenting the information logically and clearly, and keeping within the allotted time frame.

Depending on the size of the class, not all students may be able to participate in the debate, but they can all learn from it. Debates expand students’ understanding of an issue, develop their awareness of opposing views, encourage them to critically analyze issues that do not have a clear-cut answer, and help them learn how to persuade others (Bradshaw & Lowenstein, 2001).

Multimedia

Multimedia may be used to present a scenario for evaluating higher level learning. Multimedia adds to the reality of the situation as compared with presenting the scenario in print form. Any type of media may be used for this purpose. For example, video and audio clips, interactive video, CD-ROMs, Web animation, virtual reality, DVDs, and many other educational and computer technologies can be used to develop real-life scenarios for students to analyze and discuss.

There is a wealth of resources on the Web for presenting scenarios and other situations for teaching and assessing higher level cognitive skills. These can be easily integrated within an online learning environment, and students can work individually or in groups to analyze them.

Short Written Assignments

For the purposes of assessing critical thinking and other cognitive skills, however, these assignments should reflect additional principles. Assignments for this purpose should be short and require students to think critically about the topic. With term papers and other long assignments, students often summarize the literature and report on the ideas of others, rather than thinking about the topic themselves.

Short written assignments, in contrast, provide an opportunity for students to express their thinking in writing and for teachers to give prompt feedback to them on their reasoning. Students should have clear directions as to what to write about and the expected length of the assignment. Assignments can be planned throughout a course and level in a nursing program so that they build on one another, helping students to gradually develop their thinking and writing skills.

Beginnings assignments should ask students to describe a problem or an issue and how they would solve it. In these papers and other assignments students should use multiple information resources, which are of value in preparing them for evidence-based practice (Oermann, 2006).

In later assignments students can criticize arguments and develop their own positions about issues with a rationale (Lynch, Wolcott, & Huber, 2002). Examples of written assignments for assessing critical thinking, appropriate for either formative or summative evaluation, include short papers (one to two pages) that:

■ Compare different data sets

■ Compare problems and alternative approaches that could be used

■ Analyze issues

■ Analyzing different points of view, perspectives, and positions on an issue

■ Compare a student’s own and others’ positions on an issue or topic

■ Present evidence on which their reasoning is based

■ Analyze conclusions drawn, evidence to support these conclusions, and possible alternatives given the same evidence

■ Present an argument to support a position

Conclusion

The ability to solve patient and setting related problems is an essential ability to be developed and evaluated. The nurse continually makes decisions about problems, solutions, possible alternative approaches, and the best approach to use in a particular situation, after weighing the consequences of each. Critical thinking is reflective and reasoned thinking about nursing problems without a single solution. In assessing these cognitive skills, as a basic principle the teacher introduces new or novel material for analysis.

Without the introduction of new material as part of the assessment, students may rely on memorization of content from prior discussion or their readings on how to solve problems and arrive at decisions for the situation at hand; they may simply recall the typical problem and solutions without thinking through alternative possibilities themselves.

As a result, an essential component of this assessment is the introduction of new information not encountered by the student at an earlier point in the instruction. In nursing this is frequently accomplished by developing scenarios that present a novel situation to which students apply concepts and theories, problem solve, arrive at decisions, and engage in higher level thinking. These items are referred to as context-dependent item sets or interpretive exercises.

In a context-dependent item set, the teacher presents introductory material that students then analyze and answer questions about. The introductory material may be a description of a clinical situation, patient data, research findings, issues associated with clinical practice, and tables, among other types. Students read, analyze, and interpret this material and then answer questions about it or complete other tasks.