Test Item - Part 2

Unit 5: Test Item – Part 2

 

Reviewing the statistics from completed assessments in education is a very important aspect to ensure effective education is provided, student learning is occurring, and the program is being successful to protect the student, faculty, stakeholders, institution, and the community through safe, competent care in the nursing profession. Analyzing and interpreting the statistics of assessments help ensure that effective educational methods are implemented. Statistical review aids in identifying if the educator is being effective in presenting the information within the classroom and clinical settings and providing effective instruction and demonstration related to skills techniques. Reviewing the assessment statistics can aid in professional growth and development because the educator can identify and build upon their own strengths and weaknesses. Educators that will sure their experiences in test writing and statistical findings will help other educators gain knowledge and enhance their instructional techniques and skills. Finally, analyzing, interpreting, and making needed changes to the assessments, instructional methods and techniques, and activities will ensure that students are receiving and retaining the instructional material provided, each student’s needs are being met, and ensures that the students are prepared for real world professional practice. Below is a table of the statistical review of a three question developed assessment test developed in Part I of the Item Writing Blog Post.

 

Statistical Review Table: Wound Assessment and Nursing Intervention Assessment Quiz

 

Wound Assessment and Nursing Interventions
Times taken	Average Time(hh:mm:ss)	Avarage Score
4	00:01:20	83
Report Summary
Question	Option	Correct	Incorrect	Unanswered	Responses
1) You are caring for a patient with a wound located on the sacrum. The nurse noted a symptom of a possible wound infection occurring. Which symptom of infection wound the nurse might see?		4	0	0	4
	Smaller wound measurements
	Granulation tissue in the wound bed
	Clear drainage from the wound
	Foul odor from wound after cleaned				4
2) The nurse has orders to complete a sterile dressing change on a day 1 post-operative patient. The nurse would remove the old dressing before performing other dressing change tasks with _______________________.		2	2	0	4
	Sterile gloves				2
	Clean gloves				2
	Washed hands
	Sanitized hands
3) A nurse is assigned to a patient on a medical/surgical that has a stasis ulcer on the right longer extremity. The nurse has already read the MD orders that state sterile dressing changes to every 4 hours and prn. The nurse enters the room to assess the patient and notices the dressing is saturated and is producing a foul odor. What tasks should the nurse do?		4	0	0	4
	Do nothing at all and notify MD immediately
	Wait and change dressing four hours from the last change
	Change dressing, assess wound, and notify MD of findings				4
	Change dressing and wait to notify MD of findings

Shared URL link for Stats: http://www.proprofs.com/quiz-school/stats.php?title=NjAwNTUx&stat-shr-id=423dcb2f6a1bae0e64f2ddec92048a8a

 

Student Assessment Score Table: Wound Assessment and Nursing Intervention Assessment Quiz

Date	First Name	Last Name	Score %	Score	Time Taken
Dec 5  2013 09:52 PM	Student	A	100	100	1 min 36 sec
Dec 5  2013 08:33 PM	Student	B	66.67	67	1 min 48 sec
Dec 4  2013 08:14 PM	Student	C	100	100	15 sec
Dec 4  2013 08:11 PM	Student	C	66.67	67	1 min 39 sec

 

Interpretation of Statistical Results and Revision Plan

            According to McDonald (2014), analysis data that may be included of an assessment test include the number of test items, number of students that have taken the test, mean, median, high and low score, alpha, standard deviation, SEM, mean p value, and mean PBI. For this assignment, discussion of statistical analysis and interpretation will consist of the number of students that completed the test, individual test items to include the distractors chosen and not chosen with rationales, the difficulty level (p-value) with rationale to keep or revise each question item or distractor. The item question or distractors that are revised will be shared below with rationale. Based on the statistical report above 3 students completed the assessment test with 1 student taking it twice which resulted in 4 total scores reported.

 

Test item 1 statistical report shows that all 4 student responses were correct. The stem included a nursing scenario to aid in making the question as clear and precise as possible of what was being asked. The distractors were all wound assessment based with three choice answers being of a healthy wound healing process. The correct answer choice was clear and related to one of the symptoms of a wound infection that is textbook material which would be covered in lecture and lab. Each answer choice was approximately the same length to aid in the prevention of student assumption of the correct answer. The p-value is + 1.0 due to all 4 students answering the test item correctly. Test item 1 will be kept on the assessment test because the item stem was clear and precise and the correct answer and distractors had plausibility and was homogeneous.

 

1.      You are caring for a patient with a wound located on the sacrum. The nurse noted a symptom of a possible wound infection occurring. Which symptom of infection would the nurse might see?

A.    Smaller wound measurements (Incorrect)

·         The answer is incorrect because upon assessment the wound is measuring a smaller than previous measurements which is a sign of wound healing and not of a wound infection.

B.     Granulation tissue in wound bed (Incorrect)

·         The answer is incorrect because the assessment finding of wound bed granulation tissue is a sign of healthy wound healing because granulation tissue is usually pink or beefy red that notes that the wound bed is receiving a good blood flow to promote healing.

C.     Clear drainage from wound (Incorrect)

·         The answer is incorrect because a clear drainage from the wound is a normal process of wound healing. A sign of infection related to drainage from the wound is purulent (yellowish/greenish/brownish colored) drainage.

D.    Foul odor from wound after cleaned (Correct)

·         Answer D is correct because a foul odor from the wound after cleansing is a sign of possible wound infection. Sometimes prior to or during a wound dressing change a foul odor may be noted. The foul odor could be from the old dressing having drainage for a long period of time that may give off an odor. However, if after the wound is cleansed an odor is still present, the wound may be infected or getting infected. After cleansing, the wound should not have an odor (Sarvis, 2007).

 

Test item 2 statistical report shows that 2 student answer responses were correct and 2 student answer responses were incorrect. The stem of the test item was not as clear as it could have been for better understanding of what is actually being asked. A change in wording in the stem would make the question a little more clear and precise for more effective student understanding. The distractors contained 3 incorrect answer choices and 1 correct answer choice. All of the distractors were nursing process based, the same length in wording, plausible, and homogenous. All distractors were textbook material and instructional material that would be covered in class, lab, and clinical settings. The p-value for item 2 is + 0.5 due to 4 student responses with only 2 answers being correct. Test item 2 will be revised to provide a clearer and precise stem with revised distractors to improve student understanding of what is being asked. The revised item 2 is as follows:

 

2.      A sterile dressing change on an abdominal surgical incision is ordered by the physician to be completed every 12 hours and prn if soiled. The nurse would remove the soiled dressing with ________________________.

A.    Sterile gloves donned on hands that have been washed with soap and water. (Incorrect)

·         Current dressing is already soiled, sterile gloves at this point in the sterile dressing change is not needed.

B.     Clean gloves donned on hands that have been washed with soap and water. (Correct)

·         Current dressing is already soiled and is no longer sterile; therefore, the dressing should be removed with soap and water washed hands with clean gloves donned. Answer can be found at a link for Sarasota Memorial Hospital (2013), page 2, under “APPLYING A STERILE DRESSING TO A NON-DRAINING WOUND”, number 3 and 4 at http://home.smh.com/sections/services-procedures/medlib/nursing/NursPandP/wou04_Sterile_021313.pdf

C.     Non-gloved hands washed with soap and water. (Incorrect)

·         Universal precautions should always be taken to protect the nurse and the patient such as wearing gloves during dressing changes to aid in prevention of cross-contamination, decrease risk of infection for the patient, and aid in preventing the nurse from infections from possible contaminated blood or body fluids and hands are to be washed with soap and water prior to donning gloves.

D.    Non-gloved hands sanitized with alcohol based solution. (Incorrect)

·         Universal precautions should always be taken to protect the nurse and the patient such as wearing gloves during dressing changes to aid in prevention of cross-contamination, decrease risk of infection for the patient, and aid in preventing the nurse from infections from possible contaminated blood or body fluids and hands are to be washed with soap and water prior to donning gloves.

 

Test item 3 statistical report shows that all 4 student responses were correct. The stem is based on the nursing process and promotes critical thinking. The stem consists of a nursing scenario and clearly states what is being asked. The distractors are all wound related in which assesses critical thinking skills and nursing interventions to be implemented. There is only one correct answer response out of the 4 distractors. Each distractor is approximately the same length and is plausible and homogeneous. The p-value is + 1.0 due to all 4 student answer responses was correct. Test item 3 will be kept on the assessment test because the item question is assessing critical thinking and nursing interventions to be implemented. The stem is clearly stated and provides an assessment at a higher level. The distractors are plausible and homogeneous.

 

3.      A nurse is assigned to a patient on a medical/surgical unit that has stasis ulcer on the right lower extremity. The nurse has already read the MD orders that state sterile dressing changes to occur every four hours and prn. The nurse enters the room to assess the patient and notices the dressing is saturated and is producing a foul odor. What tasks should the nurse do?

A.    Do nothing at all and notify MD immediately (Incorrect)

·         No meaningful information or assessment findings can be communicated to the MD if nothing is done prior to notifying the MD such as changing the dressing and performing a thorough assessment which can lead to an undiagnosed wound infection and prolonging medical care could be potentially needed immediately.

B.     Wait and change dressing four hours from last change (Incorrect)

·         Waiting to change the dressing and perform a wound assessment several hours later after noting the saturated dressing and odor could potentially cause harm to the patient by not identifying a wound infection as soon as possible and delaying treatment needed.

C.     Change dressing, assess wound, and notify MD (Correct)

·         Orders are to change dressing every 4 hours and PRN. The dressing is saturated and has produced a foul odor. The nurse should have the knowledge that an increase in drainage and foul odor from wound area are possible signs and symptoms of a wound infection. Therefore, the nurse should change the wound dressing, perform a thorough wound assessment, and notify the MD of the findings. If tasks are completed, the nurse provided safe, competent care to and for the patient in which may identify a wound infection early and provide a means of treatment to begin early with possible new MD orders.

D.    Change dressing and wait to notify MD of findings (Incorrect)

·         The nurse would be changing the dressing; however, the assessment of the wound was not performed for documentation and MD notification and the nurse waited to notify the MD of the issue with the saturated dressing and possible increase in drainage. These interventions are unsafe because the nurse could be potentially putting the patient at risk by not identifying a possible wound infection and delaying treatment for the patient.

 

As stated above in the rationales of the correct and incorrect responses for item 3, the nurse not changing the dressing, performing a thorough wound assessment, and notifying the MD immediately of findings when found saturated and with an odor present will prolong the assessment of the wound for identification of possible signs and symptoms of infection and delaying the treatment needed if an infection present. The nurse not providing safe, competent care in a timely manner becomes an ethical and legal issue (Scemons & Elston, 2009).

 

 

References

 

 

McDonald, M. E. (2014). The Nurse Educator’s Guide to Assessing Learning Outcomes (3rd ed.). Burlington, MA: Jones & Bartlett.

 

Sarasota Memorial Hospital. (2013). Nursing procedure: Sterile dressing. Retrieved from http://home.smh.com/sections/services-procedures/medlib/nursing/NursPandP/wou04_Sterile_021313.pdf

 

Sarvis, C. M. (2007). Wound and skin care: Infected wounds tipping the balance with stones. Nursing 2007, 37(7). 62. Retrieved from http://www.nursingcenter.com/lnc/pdfjournal?AID=728887&an=00152193-200707000-00051&Journal_ID=&Issue_ID=  

 

Scemons, D. & Elston, D. (2009). Chapter 1: Ethical considerations in wound evaluation and management [Portable document format]. Nurse to Nurse Wound Care. Retrieved from http://www.mhprofessional.com/downloads/products/0071493972/scemons_ch01_p001-020.pdf