Taxonomies of Objectives Used for Assessment In Nursing Education

What is Taxonomies of Objectives

The need for clearly stated objectives becomes evident when the teacher translates them into test items and other methods of assessment. Test items need to adequately measure the behavior in the objective, for instance, to identify, describe, apply, and analyze, as it relates to the content area. Objectives may be written to reflect three domains of learning, each with its own classification or taxonomic system.

These domains are: cognitive, affective, and psychomotor. Taxonomy is a classification system that places an objective within a broader system or scheme. Although learning in nursing ultimately represents an integration of these domains, in test construction and the development of other assessment strategies, it is valuable for the domains to be considered separately.

Cognitive Domain

The cognitive domain deals with knowledge and intellectual skills. Learning within this domain includes the acquisition of facts and specific information underlying the practice of nursing; concepts, theories, and principles about nursing; and cognitive skills such as decision making, problem solving, and critical thinking. The most widely used cognitive taxonomy was developed in 1956 by Bloom and associates.

It provides for six levels of cognitive learning, increasing in complexity: knowledge, comprehension, application, analysis, synthesis, and evaluation. This hierarchy suggests that knowledge, such as recall of specific facts, is less complex and intellectually demanding than the higher levels of learning. Evaluation, the most complex level, requires judgments based on varied criteria.

For each of the levels, except for application, Bloom, Englehart, Furst, Hill, and Krathwohl (1956) identified sublevels. In an update of the taxonomy by Anderson and Krathwohl (2001), the names for the levels of learning were reworded as verbs, for example, the “knowledge” level was renamed “remembering,” and synthesis and evaluation were reordered. In the adapted taxonomy, the highest level of learning is “creating,” which is the process of synthesizing elements to form a new product.

One advantage in considering this taxonomy when writing objectives and test items is that it encourages the teacher to think about higher levels of learning expected as a result of the instruction. If the course goals reflect application of concepts in clinical practice, use of theories in patient care, and critical thinking outcomes, these higher levels of learning should be reflected in the objectives and assessment rather than focusing only on the recall of facts and other information.

In using the taxonomy, the teacher decides first on the level of cognitive learning intended and then develops objectives and assessment methods for that particular level . Decisions about the taxonomic level at which to gear instruction and assessment depend on the teacher’s judgment in considering the background of the learner; placement of the course and learning experiences within the curriculum to provide for the progressive development of knowledge, skills, and values; and complexity of the content in relation to the time allowed for teaching.

If the time for teaching and evaluation is limited, the objectives may need to be written at a lower level. The taxonomy provides a continuum for educators to use in planning instruction and evaluating learning outcomes, beginning with recall of facts and information and progressing toward understanding, using concepts and theories in practice, analyzing situations, synthesizing from different sources to develop new products, and evaluating materials and situations based on internal and external criteria.

A description and sample objective for each of the six levels of learning in Bloom’s cognitive taxonomy follow. Although sublevels have been established for these levels, except for application, only the six major levels are essential to guide the teacher for instructional and evaluation purposes.

1. Knowledge : Recall of facts and specific information: Memorization of specifics. The student defines the term systole.
2. Comprehension: Understanding: Ability to describe and explain the material. The learner describes the circulation through the heart.
3. Application: Use of information in a new situation: Ability to use knowledge in a new situation. The student applies concepts of aging in developing interventions for the elderly.
4. Analysis: Ability to break down material into component parts and identify the relationships among them. The student analyzes the organizational structure of the community health agency and its impact on client services.
5. Synthesis: Ability to develop and combine elements to form a new product. The student develops a plan for delivering services to persons with dementia and their caregivers in the home.
6. Evaluation: Ability to make value judgments based on internal and external criteria and determines the extent to which materials and objects meet criteria. The learner evaluates the quality of nursing research studies and their applicability to practice.

Benefits of Taxonomy

This taxonomy is useful in developing test items because it helps the teacher gear the item to a particular cognitive level. For example, if the objective focuses on application, the test question should measure whether the student can use the concept in a new situation, which is the intent of learning at that level. However, the taxonomy alone does not always determine the level of complexity of the item because one other consideration is how the information was presented in the instruction.

For example, a test item at the application level requires use of previously learned concepts and theories in a new situation. Whether or not the situation is new for each student, however, it is not known. Some students may have had clinical experience with that situation or been exposed to it through another learning activity.

As another example, a question written at the comprehension level may actually be at the knowledge level if the teacher used that specific explanation in class and students only need to recall the explanation to answer the item. Marzano and Kendall (2007, 2008) developed a new taxonomy for writing objectives and designing assessment. Their taxonomy addresses three domains of knowledge information, mental procedures, and psychomotor procedures and six levels of processing.

The levels of processing begin with retrieval, the lowest cognitive level (First Level), which is recalling information without understanding it and performing procedures accurately but without understanding their rationale. At the second level, comprehension, the learner understands information and its critical elements. The third level is analysis, which involves identifying consequences of information, deriving generalizations, analyzing errors, classifying, and identifying similarities and differences.

The next level(Fourth Leve) knowledge usage is the ability to use information to conduct investigations, generate and test hypotheses, solve problems, and make decisions. Level 5 is metacognition, during which the learner explores the accuracy of information and his or her own clarity of understanding, develops goals, and monitors progress in meeting these goals.

The level, self-system thinking(Sixth Level), occurs when the student identifies his or her own motivations to learn, emotional responses to learning, and beliefs about the ability to improve competence, and then examines the importance of the information, mental procedure, or psychomotor procedure for him or herself.

Affective Domain

The affective domain relates to the development of values, attitudes, and beliefs consistent with standards of professional nursing practice. Developed by Krathwohl, Bloom, and Masia (1964), the taxonomy of the affective domain includes five levels organized around the principle of increasing involvement of the learner and internalization of a value. T

he principle on which the affective taxonomy is based relates to the movement of learners from mere awareness of a value, for instance, confidentiality, to internalization of that value as a basis for their own behavior. There are two important dimensions in evaluating affective outcomes. The first relates to the student’s knowledge of the values, attitudes, and beliefs that are important in guiding decisions in nursing.

Prior to internalizing a value and using it as a basis for decision making and behavior, the student needs to know what important values in nursing are. There is a cognitive basis, therefore, to the development of a value system. Evaluation of this dimension focuses on acquisition of knowledge about the values, attitudes, and beliefs consistent with professional nursing practice.

A variety of test items and assessment methods are appropriate to evaluate this knowledge base. The second dimension of affective evaluation focuses on whether or not students have accepted these values, attitudes, and beliefs and are internalizing them for their own decision making and behavior. Assessment at these higher levels of the affective domain is more difficult because it requires observation of student behavior over time to determine whether there is commitment to act according to professional values.

Test items are not appropriate for these levels as the teacher is concerned with the use of values in practice and the motivation to carry them out consistently in patient care. A description and sample objective for each of the five levels of learning in the affective taxonomy follow:

1. Receiving: Awareness of values, attitudes, and beliefs important in nursing practice. Sensitivity to a patient, clinical situation, problem. The student expresses an awareness of the need for maintaining confidentiality of patient information.
2. Responding: Learner’s reaction to a situation. Responding voluntarily to a given phenomenon reflecting a choice made by the learner. The student willingly shares feelings about caring for a dying patient.
3. Valuing: Internalization of a value . Acceptance of a value and the commitment to using that value as a basis for behavior. The learner supports the rights of patients to make their own decisions about care.
4. Organization: Development of a complex system of values. Creation of a value system. The learner forms a position about issues relating to the cost effectiveness of interventions.
5. Characterization by a value: Internalization of a value system providing a philosophy for practice. The learner acts consistently to involve patients and families in decisions making about care.

Psychomotor Domain

Psychomotor learning involves the development of skills and competence in the use of technology. This domain includes activities that are movement oriented, requiring some degree of physical coordination. Motor skills have a cognitive base, which involves the principles underlying the skill. They also have an affective component reflecting the values of the nurse while carrying out the skill, for instance, respecting the patient while performing the procedure.

Different taxonomies have been developed for the evaluation of psychomotor skills. One taxonomy useful in nursing education specifies five levels in the development of psychomotor skills. The lowest level is imitation learning; here the learner observes a demonstration of the skill and imitates that performance. At the second level, the learner performs the skill following written guidelines.

By practicing skills the learner refines the ability to perform them without errors (precision) and in a reasonable time frame (articulation) until they become a natural part of care (naturalization) (Dave, 1970; Gaberson & Oermann, 2007). A description of each of these levels and sample objectives follows:

1. Imitation: Performance of a skill following demonstration by teacher or through multimedia. Imitative learning. The student follows the example for changing a dressing room .
2. Manipulation: Ability to follow instructions rather than needing to observe the procedure or skill. The student suctions a patient according to the accepted procedure.
3. Precision: Ability to perform a skill accurately, independently, and without using a model or set of directions. The student takes vital signs accurately.
4. Articulation: Coordinated performance of a skill within a reasonable time frame. The learner demonstrates skill in suctioning patients with varying health problems.
5. Naturalization: High degree of proficiency. Integration of skills within care. The learner competently carries out skills needed to care for technology-dependent children in their homes.

Assessment methods for psychomotor skills provide data on knowledge of the principles underlying the skill and ability to carry out the procedure in simulations and with patients. Most of the evaluation of performance is done in the clinical setting and in learning and simulation laboratories; However, test items may be used for assessing principles associated with performing the skill.

Integrated Framework In Learning Domains

One other framework that could be used to classify objectives was developed by Miller et al. (2009, pp. 54–55). This framework integrates the cognitive, affective, and psychomotor domains into one list and can be easily adapted for nursing education:

1. Knowledge (knowledge of terms, facts, concepts, and methods)
2. Understanding (understanding concepts, methods, written materials, and problem situations)
3. Application (of factual information , concepts, methods, and problem-solving skills)
4. Thinking skills (critical and scientific thinking)
5. General skills (laboratory, performance, communication, and other skills)
6. Attitudes (and values, for example, reflecting standards of nursing practice)
7. Interests (personal, educational, and occupational)
8. Appreciations (literature, art, and music; scientific and social achievements), and
9. Adjustments (social and emotional).