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