Module 3
Higher-Level Learning in Nursing Education
A. Higher Level Learning
In preparing students to meet the needs of patients within the changing healthcare
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 decisions. These cognitive skills
include, among others, the ability to apply concepts to new situations, problem-solving,
critical thinking, and clinical judgment. The purpose of this chapter is to present methods
for assessing these higher levels of learning in nursing.
One of the concepts presented in Chapter 1, Assessment and the Educational
Process, was that outcomes can be organized in a cognitive hierarchy or taxonomy, with
each level representing more complex learning than the previous one. Learning extends
from simple remembering and understanding, which are lower level cognitive behaviors,
to higher level thinking skills. Higher level cognitive skills include applying, analyzing,
evaluating, and creating. With higher level thinking, students apply concepts and other
forms of knowledge to new situations, use that knowledge to interpret patient needs and
identify patient and other types of problems, and arrive at carefully thought-out
judgments 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.
The assessment of students' ability to apply their learning in different contexts is a
critical component of educational effectiveness, particularly in fields where practical
application is paramount, such as in healthcare, engineering, business, and many others.
This ability goes beyond mere memorization of facts and concepts; it requires students to
demonstrate their understanding through the application of knowledge in diverse and
often unfamiliar situations. The concept of assessing students in different contexts
revolves around the idea of transference of learning. It involves students' capacity to take
what they have learned in one setting or scenario and apply it effectively in novel or
varied situations. This skill is essential for ensuring that education prepares students not
just for specific tasks or exams but for real-world challenges they may encounter in their
careers. Assessing students' ability to use their learning in different contexts requires
them to exhibit cognitive flexibility. They must be able to recognize underlying
principles, adapt their knowledge to new circumstances, and solve problems creatively.
This process encourages deeper understanding and retention of concepts, as students
engage in higher-order thinking rather than simply recalling information.
To effectively evaluate this capability, assessments should be designed to mirror
real-world scenarios as closely as possible. This may involve case studies, simulations,
project-based assignments, or problem-solving tasks that present students with authentic
challenges requiring them to draw on their learning in innovative ways. Such assessments
not only measure students' ability to apply knowledge but also reinforce the practical
relevance of their education. Incorporating reflection and metacognitive practices into
assessments encourages students to think critically about their own learning processes.
By reflecting on how and why they approached a problem or made decisions in a specific
context, students gain insights into their strengths, weaknesses, and areas for
improvement. This self-awareness enhances their ability to transfer learning effectively
across different contexts in the future.
Providing constructive feedback is crucial in supporting students' development of
transferable skills. Feedback should not only assess the accuracy of their solutions but
also provide guidance on how to enhance their approach to problem-solving and
application of knowledge. Iterative learning opportunities allow students to refine their
skills over time, reinforcing their ability to apply learning in diverse contexts more
effectively. Encouraging interdisciplinary connections in education promotes broader
perspectives and enhances students' ability to transfer learning across different fields.
Collaborative projects or cross-disciplinary assignments challenge students to integrate
knowledge from multiple domains, fostering a holistic understanding that can be applied
across various professional settings. By emphasizing assessments that measure students'
capacity to apply their learning in different contexts, educators equip learners with the
skills necessary for success beyond the classroom. This approach not only validates the
practical relevance of education but also prepares students to adapt and innovate in an
increasingly complex and interconnected world.
Assessing students' ability to apply their learning in diverse contexts is crucial
because it ensures that education transcends isolated domains, fostering a foundation for
lifelong problem-solving and professional growth. This approach emphasizes the
practical application of knowledge across various situations and disciplines, preparing
students to navigate real-world challenges effectively and adapt to evolving professional
landscapes. By assessing students' capability to transfer learning across different contexts,
educators promote holistic skill development. Rather than focusing solely on rote
memorization or mastery of specific content, assessments challenge students to integrate
knowledge, apply critical thinking, and innovate in response to multifaceted problems.
This holistic approach nurtures versatile learners who can contribute meaningfully across
diverse fields and environments. Assessments designed to measure transferable skills
encourage adaptability and innovation. Students learn to approach unfamiliar scenarios
with confidence, drawing on their foundational understanding to devise creative
solutions. This ability is essential in professions where rapid technological advancements
and shifting global trends demand agile thinkers who can anticipate and respond to
change proactively.
By embedding practical application into assessments, educators underscore the
real-world relevance of learning outcomes. Students recognize the immediate
applicability of their education to professional settings, enhancing their motivation and
engagement. This connection between theory and practice empowers learners to see
education as a dynamic tool for addressing contemporary challenges and contributing
positively to society. Assessing transferable skills cultivates a lifelong learning mindset
among students. They understand that learning extends beyond graduation and
encompasses continuous adaptation and growth. This mindset is particularly valuable in
industries where ongoing professional development and mastery of emerging
technologies are integral to career advancement and competitiveness. Education that
prioritizes the application of learning in diverse contexts equips students to tackle
complex challenges with resilience and efficacy. They develop the confidence to navigate
ambiguity, collaborate across disciplines, and leverage diverse perspectives to achieve
innovative outcomes. This readiness is crucial in fostering leaders and problem-solvers
capable of addressing global issues and driving sustainable progress.
Employers increasingly value candidates who possess transferable skills such as
critical thinking, communication, and problem-solving. Assessments that demonstrate
these competencies provide students with a competitive edge in the job market. They
showcase the ability to contribute immediately and adaptably to organizational goals,
enhancing employability and career advancement prospects. In essence, assessing
students' ability to apply learning in diverse contexts ensures that education prepares
them not only for immediate academic success but also for lifelong professional growth
and societal contribution. It promotes a comprehensive understanding of how knowledge
can be effectively wielded to address multifaceted challenges, fostering individuals who
are not just adept learners but proactive agents of positive change in their communities
and beyond.
In the dynamic realm of healthcare, where patient characteristics, conditions, and
interventions frequently diverge from textbook scenarios, and where health statuses can
evolve rapidly, it becomes paramount for students to cultivate robust clinical reasoning
skills. These skills enable them to navigate complex clinical situations effectively and
make informed decisions that optimize patient care outcomes. The discrepancy between
textbook descriptions and real-world clinical scenarios underscores the importance of
experiential learning and critical thinking in medical education. While textbooks provide
foundational knowledge and standardized approaches, actual patient encounters often
present with nuanced variations, comorbidities, and unforeseen complications. Therefore,
students must develop the capacity to adapt their knowledge to diverse and unpredictable
clinical contexts.
Clinical reasoning involves the cognitive processes through which healthcare
professionals analyze clinical data, interpret findings, and formulate diagnoses or
treatment plans. It requires synthesizing information from multiple sources—including
patient history, physical examination findings, diagnostic tests, and patient responses—to
develop a comprehensive understanding of the patient's condition and determine
appropriate interventions. Moreover, the ability to think critically in clinical settings
extends beyond technical proficiency. It encompasses skills such as clinical judgment,
which involves assessing the significance of clinical findings, weighing alternative
courses of action, and anticipating potential outcomes and complications. This holistic
approach to clinical reasoning prepares students to address the inherent uncertainties and
complexities of healthcare practice.
To foster effective clinical reasoning skills, medical education must integrate
active learning methodologies that simulate real-world scenarios and encourage reflective
practice. Case-based learning, simulations, and problem-solving exercises allow students
to apply theoretical knowledge in contextually rich environments, where they can
practice making clinical decisions under varying conditions and constraints. Furthermore,
mentorship and feedback play pivotal roles in nurturing clinical reasoning abilities.
Experienced clinicians serve as role models, guiding students in navigating diagnostic
dilemmas, ethical considerations, and patient management challenges. Constructive
feedback helps students refine their reasoning processes, identify areas for improvement,
and develop confidence in their clinical decision-making capabilities.
Incorporating interdisciplinary collaboration and communication skills into
medical education further enhances clinical reasoning. Effective teamwork enables
healthcare professionals to leverage diverse perspectives, share expertise, and collectively
devise optimal care plans tailored to individual patient needs. Ultimately, by emphasizing
the development of clinical reasoning skills alongside technical competencies, medical
education prepares future healthcare professionals to deliver patient-centered care that is
adaptive, evidence-based, and responsive to the dynamic nature of clinical practice. This
approach not only enhances patient outcomes but also cultivates a generation of
healthcare providers who are adept at navigating the complexities and uncertainties
inherent in modern healthcare delivery.
Introducing novel materials into assessments offers educators a powerful method
to evaluate the cognitive skills and overall understanding of their students. This approach
goes beyond traditional testing methods by challenging students to apply their knowledge
in new and unfamiliar contexts, thereby assessing their ability to think critically,
problem-solve, and synthesize information. When educators integrate novel materials
into assessments, they provide students with opportunities to demonstrate deeper levels of
comprehension and application. For instance, instead of relying solely on rote
memorization or basic comprehension questions, assessments incorporating novel
materials may include case studies, real-world scenarios, or complex texts that require
students to analyze, evaluate, and draw conclusions based on their understanding.
Moreover, the use of novel materials in assessments encourages creativity and innovation
in both teaching and learning. It stimulates students' curiosity and engagement by
presenting them with content that may be outside their usual scope of study, prompting
them to explore new ideas and perspectives. This approach not only enhances their
cognitive abilities but also fosters a more dynamic and inclusive learning environment.
From a pedagogical standpoint, integrating novel materials aligns with
contemporary educational frameworks that emphasize the development of higher-order
thinking skills. These skills, including critical thinking, problem-solving, and analytical
reasoning, are essential for students to succeed in today's complex and rapidly changing
world. Assessments that incorporate novel materials provide a more authentic measure of
these skills, offering insights into students' ability to apply knowledge in diverse and
unpredictable situations. Furthermore, by diversifying assessment strategies to include
novel materials, educators cater to different learning styles and preferences among
students. Some learners may excel in traditional formats, while others may demonstrate
their strengths more effectively when presented with new challenges and materials. This
inclusive approach promotes equity and fairness in assessments, ensuring that all students
have the opportunity to showcase their learning and growth.
In practice, educators can implement various techniques to integrate novel
materials into assessments. They may include multimedia resources, primary source
documents, multimedia presentations, simulations, or interactive exercises that require
students to analyze and interpret information in innovative ways. These approaches not
only enhance the authenticity of assessments but also provide richer insights into
students' cognitive development and mastery of learning objectives. In conclusion, the
strategic use of novel materials in assessments represents a progressive approach to
evaluating student learning. By challenging students to apply their knowledge in diverse
contexts and formats, educators can gain deeper insights into their cognitive skills,
critical thinking abilities, and overall academic growth.
Assessing students' ability to apply their learning in diverse contexts not only
enriches assessment practices but also cultivates a more comprehensive educational
experience that equips students for success in the complexities of the 21st century. This
approach goes beyond traditional assessments focused solely on content mastery,
emphasizing the development of critical thinking, problem-solving, and adaptability—
skills essential for navigating an increasingly interconnected and rapidly evolving world.
By incorporating practical application into assessments, educators bridge the gap between
theoretical knowledge and real-world application. Students are challenged to analyze
complex problems, evaluate information from multiple sources, and propose innovative
solutions. This integration fosters a deeper understanding of how academic concepts
translate into practical scenarios, preparing students to address challenges across various
disciplines and professional environments. Assessments that emphasize transferable skills
promote a lifelong learning mindset among students. They recognize the value of
continuous learning and adaptation in response to technological advancements, societal
changes, and global trends. This mindset is crucial for maintaining relevance and
competence throughout one's career and for embracing opportunities for personal and
professional growth.
In today's interconnected world, success often hinges on the ability to navigate
complexity and ambiguity. Assessments that require students to apply learning in diverse
contexts prepare them to confront multifaceted challenges with confidence and resilience.
They learn to collaborate effectively, communicate ideas persuasively, and leverage
diverse perspectives to achieve collective goals—a skill set that is increasingly valued in
globalized workplaces. Assessments focused on application cultivate critical thinking and
problem-solving abilities. Students learn to identify underlying issues, evaluate evidence,
and formulate reasoned judgments. These cognitive skills are transferable across
academic disciplines and professional domains, empowering students to make informed
decisions and contribute meaningfully to society. Incorporating practical application into
assessments enhances student engagement and motivation. When learning is directly
relevant to their lives and future careers, students are more likely to invest effort in
understanding and mastering concepts. This intrinsic motivation fuels deeper learning
and persistence in overcoming challenges, leading to greater academic achievement and
personal satisfaction.
Beyond academic and professional success, assessments that emphasize
application foster the development of global citizenship. Students gain an appreciation for
cultural diversity, ethical decision-making, and social responsibility. They are prepared to
engage as informed and empathetic members of their communities, contributing
positively to local and global challenges such as sustainability, social justice, and public
health. In conclusion, assessing students' ability to apply learning in diverse contexts not
only enhances assessment practices but also enriches the overall educational experience.
It equips students with essential skills and competencies needed to thrive in the
complexities of the 21st century, fostering a generation of adaptable, resourceful, and
ethical leaders prepared to tackle global challenges and drive positive change. This
comprehensive approach ensures that education remains relevant, impactful, and
transformative, empowering individuals to fulfill their potential and contribute
meaningfully to a rapidly evolving world.
B. Problem-Solving
In the practice setting, students are continually faced with patient and other
clinical 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, collaboration with other providers, and the work environment. The
ability to solve patient and setting-related problems is an essential skill to be developed
by students. Problem-solving begins with recognizing and defining the problem,
gathering data to clarify it further, thinking through possible approaches to use, and
evaluating their outcomes. 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 assessment. When students have an understanding
of the problem and possible solutions, they can more easily apply this knowledge to new
situations they encounter in the clinical setting.
Past experience with similar problems, whether encountered in real clinical
settings, simulated scenarios, or examples used in teaching, significantly influences
students' skill in problem-solving. This experiential learning approach enriches students'
ability to navigate complex clinical challenges by providing practical insights, fostering
critical thinking, and enhancing their overall clinical competence. When students
encounter similar clinical problems repeatedly, they apply theoretical knowledge to
practical situations. This application bridges the gap between classroom learning and
clinical practice, reinforcing concepts and principles through real-world application.
Students learn to integrate theoretical understanding with hands-on experience, enhancing
their ability to analyze and address clinical challenges effectively. Simulated scenarios
offer a controlled environment where students can practice clinical skills and decision-
making processes. These simulations replicate realistic patient care scenarios, allowing
students to apply clinical reasoning, prioritize interventions, and evaluate outcomes. By
engaging in simulated experiences, students develop confidence in their abilities and gain
valuable insights into managing diverse patient presentations.
Engaging with past experiences encourages reflective practice among students.
They critically analyze their actions, decisions, and outcomes in clinical scenarios,
identifying strengths and areas for improvement. Constructive feedback from educators,
preceptors, and peers enhances students' self-awareness and encourages iterative learning.
This reflective cycle fosters continuous improvement in problem-solving skills and
prepares students for adaptive practice in dynamic healthcare environments. Past
experiences with clinical problems reinforce the importance of evidence-based practice.
Students learn to evaluate research findings, clinical guidelines, and best practices to
inform their decision-making process. They understand the value of integrating current
evidence into patient care, ensuring that interventions are grounded in research and
tailored to individual patient needs. This evidence-based approach enhances the quality
and efficacy of problem-solving in clinical practice.
Collaboration with healthcare teams during past experiences enhances students'
ability to problem-solve collaboratively. They learn to communicate effectively with
interdisciplinary team members, share perspectives, and coordinate care plans.
Interprofessional collaboration promotes comprehensive patient-centered care, where
diverse expertise contributes to holistic problem-solving and improved patient outcomes.
Exposure to a range of clinical problems in past experiences prepares students for diverse
healthcare settings and patient populations. Whether in acute care hospitals, community
health centers, or outpatient clinics, students develop versatility in applying problem-
solving skills across different environments. This adaptability is essential for navigating
the complexities of modern healthcare delivery and promoting continuity of care. Past
experiences challenge students to think critically and analytically about clinical problems.
They learn to assess complex situations, identify underlying factors, and formulate
evidence-based solutions. Critical thinking skills enable students to anticipate challenges,
adapt interventions as needed, and optimize patient outcomes through informed decision-
making. In conclusion, past experiences with similar clinical problems play a pivotal role
in shaping students' problem-solving skills and clinical competence. By engaging in
practical application, reflective practice, and evidence-based decision-making, students
develop the proficiency and confidence needed to excel in healthcare practice. These
experiences not only prepare students for the challenges of clinical practice but also
instill a commitment to lifelong learning and continuous improvement in providing
patient-centered care.
Experience with similar problems provides students with invaluable insights and
perspectives that are instrumental in clinical practice. This familiarity not only prepares
students for what to expect in various clinical situations but also equips them with
effective approaches to address common patient problems. When students encounter
recurring clinical scenarios, they develop enhanced clinical judgment. They learn to
recognize patterns, anticipate potential complications, and prioritize interventions based
on previous experiences. This familiarity with typical patient problems enables students
to navigate clinical situations more confidently and efficiently. Experience with similar
problems allows students to apply evidence-based practices effectively. They become
adept at selecting appropriate diagnostic tests, interpreting results, and implementing
evidence-based treatment protocols. This application of best practices enhances patient
care outcomes and reinforces the importance of integrating current research into clinical
decision-making.
Engaging with similar clinical problems fosters the development of critical
thinking and problem-solving skills. Students learn to evaluate complex scenarios,
identify underlying issues, and devise tailored solutions. This process encourages
creativity and adaptability in problem-solving, preparing students to address unique
challenges that may arise in clinical practice. Experience with common patient problems
enhances students' communication skills. They learn to effectively communicate with
patients, families, and interdisciplinary healthcare teams about diagnoses, treatment
options, and care plans. Clear and empathetic communication fosters patient trust and
collaboration, contributing to improved patient satisfaction and adherence to treatment
recommendations.
Exposure to recurring clinical problems encourages students to adopt a holistic
approach to patient care. They understand the interconnectedness of physical, emotional,
and social factors influencing health outcomes. This holistic perspective promotes
comprehensive assessments, personalized care plans, and patient-centered interventions
that address the diverse needs of individuals and communities. Experience with similar
problems prepares students for diverse clinical settings and patient populations. Whether
in hospital wards, outpatient clinics, or community health centers, students gain
versatility in applying their knowledge and skills across different healthcare
environments. This adaptability is essential for navigating the complexities of modern
healthcare delivery and promoting continuity of care.
Engaging with recurring clinical problems fosters a commitment to continual
learning and professional growth. Students recognize the importance of ongoing
education, skill development, and reflection in enhancing their clinical practice. They
seek opportunities to expand their knowledge base, refine their clinical skills, and stay
abreast of advancements in medical research and practice guidelines. In summary,
experience with similar clinical problems enriches students' educational journey by
providing practical insights, refining clinical competencies, and fostering a patient-
centered approach to healthcare delivery. This experiential learning not only enhances
students' preparedness for clinical practice but also instills a commitment to lifelong
learning and excellence in patient care. By leveraging their experiences with typical
patient problems, students contribute positively to healthcare outcomes and continue to
evolve as compassionate, skilled, and knowledgeable healthcare professionals.
Brookhart and Nitko (2019) 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. 226). These are
problems and solutions that the teacher may have presented in class or online and then
asked students about in an assessment. Well-structured problems provide practice in
applying concepts learned in class to scenarios and other exemplars but do not require
extensive thinking skills. In contrast, ill-structured problems reflect real-life problems and
clinical situations that students encounter in practice. 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 approaches to take and how to interpret the clinical
situation. Some assessment methods may address well-structured problems, assessing
understanding of typical problems and approaches. Other methods assess students’ ability
to analyze situations to interpret patient needs and concerns, identify possible problems
given the data, identify additional data needed, compare and reason through multiple
potential approaches, and arrive at an informed judgment as to actions to take (or not) in
the situation.
C. Critical Thinking
There has been extensive literature in nursing for many decades about the
importance of students developing the ability to think critically. The complexity of
patient needs, the extensive amount of information the nurse has to process and analyze
in the practice setting, the types of clinical judgments required for providing quality and
safe care, and multiple ethical issues faced by the nurse require the ability to think
critically. Many definitions of critical thinking exist. One way to view critical thinking is
that it is the ability to use higher level cognitive skills such as analysis to think through
situations and arrive at appropriate judgments and actions; it is being deliberate about
thinking (Alfaro-LeFevre, 2017; Papp et al., 2014). To engage in critical thinking,
students need a knowledge base to understand the situation, analyze clinical information,
make informed decisions, and reflect on the thinking process.
Critical thinking in healthcare education depends significantly on prior knowledge
and understanding of patient problems or concepts. Without a solid foundation of
knowledge and familiarity with relevant concepts, students may struggle to effectively
engage in critical thinking processes. Critical thinking builds upon a strong foundation of
knowledge acquisition. Students must first learn about patient problems, medical
conditions, diagnostic procedures, treatment options, and healthcare protocols through
didactic instruction, practical training, and experiential learning. This foundational
knowledge provides the basis for understanding the complexities of healthcare scenarios
and informs students' ability to critically analyze and evaluate information.
Once students have acquired foundational knowledge, they can apply this
knowledge in clinical scenarios to engage in critical thinking. For example, when
presented with a patient case study or simulation exercise, students draw upon their
understanding of pathophysiology, pharmacology, and clinical guidelines to assess
symptoms, formulate differential diagnoses, and propose evidence-based interventions.
The application of prior knowledge facilitates informed decision-making and enhances
students' ability to address healthcare challenges effectively. Critical thinking skills
encompass various cognitive processes, including analysis, interpretation, evaluation,
inference, and problem-solving. These skills are honed through deliberate practice and
reflection on clinical experiences. As students encounter diverse patient problems and
complex healthcare scenarios, they develop the ability to critically assess information,
identify relevant factors, weigh alternatives, and make reasoned judgments. The
integration of critical thinking skills into clinical practice promotes thoroughness,
accuracy, and efficiency in patient care delivery.
Clinical reasoning involves the cognitive processes used by healthcare
professionals to analyze patient data, prioritize assessments, and develop care plans.
Effective clinical reasoning relies on a synthesis of prior knowledge, clinical experience,
and critical thinking abilities. Students learn to recognize patterns, anticipate outcomes,
and adapt their approach based on evolving patient needs. Through deliberate practice
and mentorship, students refine their clinical reasoning skills and become proficient in
making sound clinical judgments. Healthcare education emphasizes continual learning
and skill development to prepare students for lifelong professional practice. Beyond
initial knowledge acquisition, students engage in ongoing education, professional
development activities, and interdisciplinary collaborations to expand their expertise and
stay updated with advances in healthcare. Continuous learning fosters adaptive thinking,
innovation, and resilience in addressing emerging healthcare challenges. In conclusion,
students' engagement in critical thinking in healthcare education hinges on their prior
learning about patient problems or concepts. By acquiring foundational knowledge,
applying this knowledge in clinical scenarios, integrating critical thinking skills,
developing clinical reasoning abilities, and embracing lifelong learning, students enhance
their readiness to navigate complex healthcare environments and deliver high-quality
patient care. Educators play a pivotal role in scaffolding students' learning experiences,
fostering a culture of inquiry, and promoting the development of critical thinking
competencies essential for professional competence and success in healthcare practice.
In the clinical setting, critical thinking enables the student to arrive at sound
judgments about patient care. Carrying out assessment; planning care; intervening with
patients, families, and communities; and evaluating the effectiveness of interventions—
all of these require critical thinking. In the assessment process, important cognitive skills
include differentiating relevant from irrelevant data, identifying cues in the data,
identifying additional data to collect prior to deciding on the problem, and specifying
patient needs and problems based on these data. Critical thinking also is reflected in the
ability to compare possible interventions, considering the evidence, to decide on the best
approaches to use in a particular situation.
Judgments about the quality and effectiveness of care are profoundly influenced
by the learner's thinking skills, particularly their ability to critically evaluate information,
analyze complex situations, and make informed decisions. In healthcare settings, where
patient outcomes hinge on accurate assessments and timely interventions, the quality of
care delivered is intricately linked to the cognitive abilities of healthcare professionals.
Healthcare professionals, including nurses, physicians, and allied health practitioners,
rely on critical thinking to assess patient conditions, interpret diagnostic data, and
formulate appropriate treatment plans. Critical thinking involves analyzing information
objectively, identifying relevant factors, and considering alternative perspectives before
making clinical decisions. The ability to critically evaluate evidence and apply clinical
reasoning enables healthcare learners to determine the most effective interventions that
align with patient needs and best practices.
Effective care delivery often involves addressing complex healthcare challenges
and unexpected clinical scenarios. Healthcare learners with strong problem-solving
abilities can navigate uncertainties, adapt to changing circumstances, and implement
innovative solutions to optimize patient outcomes. By applying systematic problem-
solving approaches, such as identifying root causes, generating solutions, and evaluating
outcomes, learners enhance their ability to deliver high-quality care that meets patient
expectations and clinical standards. Judgments about care quality are increasingly
informed by evidence-based practice, which integrates the best available research
evidence with clinical expertise and patient preferences. Healthcare learners proficient in
evidence-based practice critically appraise research literature, assess the validity and
reliability of findings, and apply evidence to inform clinical decisions. By prioritizing
evidence-based interventions, learners ensure that care practices are grounded in
scientific rigor and are likely to achieve desired patient outcomes.
The ability to engage in clinical reasoning is essential for healthcare learners to
evaluate patient symptoms, identify underlying health issues, and develop personalized
care plans. Through clinical reasoning, learners consider the unique needs, preferences,
and circumstances of each patient, thereby promoting patient-centered care. Judgments
about care quality reflect learners' capacity to apply clinical reasoning skills effectively,
ensuring that care decisions align with evidence, ethics, and patient values. Effective
communication and collaboration among healthcare team members are vital for
coordinating care and enhancing care quality. Healthcare learners who demonstrate
strong communication skills can convey critical information, share insights, and engage
in collaborative decision-making with colleagues. By fostering open dialogue and mutual
respect, learners contribute to a cohesive healthcare team environment where
interdisciplinary perspectives enrich care planning and implementation.
Continuous learning and professional development enable healthcare learners to
stay abreast of advancements in healthcare practices, technologies, and patient care
strategies. By pursuing ongoing education, attending professional conferences, and
participating in skill-building workshops, learners enhance their thinking skills and
expand their clinical competencies. Continuous professional development supports
learners in making informed judgments about care quality based on current best practices
and emerging trends in healthcare delivery. In summary, judgments about the quality and
effectiveness of care are shaped by healthcare learners' thinking skills, including critical
thinking, problem-solving abilities, evidence-based practice proficiency, clinical
reasoning, communication, and ongoing professional development. These cognitive
abilities empower learners to deliver patient-centered care, collaborate effectively with
healthcare teams, and uphold high standards of clinical excellence. By cultivating strong
thinking skills, healthcare learners contribute to improved patient outcomes, enhanced
care experiences, and continuous advancement in healthcare quality and safety.
Nurses, throughout their professional development, continually refine their
clinical reasoning and critical thinking skills through reflective practice. This ongoing
process is essential for enhancing patient care, improving clinical outcomes, and
advancing professional competence. Reflective practice involves nurses consciously
analyzing their actions, decisions, and experiences in clinical settings. By reflecting on
patient interactions, clinical outcomes, and their own responses to situations, nurses gain
insights into their practice. They assess what worked well, areas for improvement, and
strategies to enhance patient care. This reflective process fosters self-awareness,
promotes learning from experience, and encourages continuous professional growth.
Nurses engage in continuous learning to stay updated with advancements in
healthcare practices, evidence-based guidelines, and technological innovations.
Continuing education programs, workshops, conferences, and certifications provide
opportunities for nurses to expand their knowledge base and refine their critical thinking
skills. By integrating new knowledge into practice, nurses enhance their ability to
critically assess patient needs, interpret complex data, and implement effective
interventions. Nurses frequently encounter dynamic and unpredictable situations in
healthcare settings. Critical thinking enables nurses to analyze information, evaluate
alternatives, and make sound decisions under pressure. They assess patient symptoms,
interpret diagnostic results, and collaborate with interdisciplinary teams to develop
holistic care plans. Critical thinking skills empower nurses to adapt to changing
conditions, prioritize patient safety, and optimize clinical outcomes.
Effective healthcare delivery relies on collaborative decision-making among
healthcare professionals. Nurses collaborate with physicians, pharmacists, therapists, and
other team members to coordinate patient care and address multifaceted health issues.
Critical thinking facilitates effective communication, mutual respect, and shared
decision-making processes. Nurses contribute valuable insights, advocate for patient
needs, and contribute to comprehensive care plans that promote patient well-being.
Nurses navigate ethical dilemmas and advocate for patients' rights throughout their
practice. Critical thinking enables nurses to recognize ethical issues, analyze
implications, and make ethically informed decisions. They advocate for patient
autonomy, confidentiality, and informed consent, ensuring ethical principles guide their
practice. Critical thinking skills empower nurses to uphold professional standards,
promote patient advocacy, and contribute to ethical healthcare practices.
Nurses engage in quality improvement initiatives to enhance patient care
outcomes and optimize healthcare delivery. They analyze clinical data, identify trends,
and implement evidence-based practices to improve patient safety and satisfaction.
Critical thinking skills enable nurses to assess processes, implement changes, and
evaluate outcomes to drive continuous improvement in healthcare practices. Nurses play
a crucial role in enhancing healthcare quality, reducing risks, and achieving
organizational goals through critical analysis and evidence-based interventions. In
conclusion, nurses continually develop their clinical reasoning and critical thinking skills
through reflective practice, ongoing education, problem-solving in dynamic
environments, collaborative decision-making, ethical considerations, and quality
improvement initiatives. These skills are integral to providing safe, effective, and patient-
centered care across diverse healthcare settings. By cultivating critical thinking skills,
nurses contribute to professional excellence, enhance healthcare outcomes, and advocate
for optimal patient well-being throughout their careers.
D. Clinical Judgment
Tanner (2006) viewed clinical judgment as an interpretation of the patient’s needs
and problems, and decisions on actions to take, or not take, based on the patient’s
responses. The clinical judgment process includes four aspects: (a) noticing, (b)
interpreting, (c) responding, and (d) reflecting. Tanner’s model provides a framework for
assessing students’ thinking in a clinical situation or scenario. Students can be asked to
describe what they would expect to find in the situation, what they noticed first, and other
data they need (noticing). To assess students’ ability to interpret a situation, the teacher
can ask them to explain specific data and what they mean, and their priorities of care
(interpreting).
In nursing and healthcare education, fostering clinical reasoning and decision-
making skills among students is essential for preparing them to provide effective patient
care. One effective strategy to enhance these skills is through structured questioning that
encourages students to explore and articulate their thought processes regarding patient
interventions. Students begin by identifying the specific needs of the patient based on
assessment data, clinical findings, and patient history. Questions may prompt students to
describe the patient's condition, symptoms, and potential healthcare goals. Students
explore evidence-based interventions that align with the patient's needs and clinical
guidelines. They evaluate the effectiveness, safety, and feasibility of different
intervention options.
Questions may encourage students to consider input from healthcare team
members, interdisciplinary collaboration, and patient preferences when selecting
interventions. Students critically analyze the advantages and disadvantages of each
intervention option. They weigh the potential benefits, risks, and ethical considerations
associated with implementing or withholding interventions. Students prioritize
interventions based on the urgency of patient needs, severity of symptoms, and
anticipated outcomes. They justify their decision-making process through logical
reasoning and clinical judgment. Questions prompt students to apply clinical reasoning
skills to connect theoretical knowledge with practical application. They explain how they
arrived at their decision, considering patient-specific factors, evidence-based practices,
and professional standards of care. Students articulate their rationale for selecting specific
interventions or deciding not to intervene. They discuss the alignment of interventions
with patient goals, anticipated benefits for patient outcomes, and ethical implications of
their decisions.
Students provide evidence-based justification supported by current research
literature, clinical guidelines, and best practice recommendations. They demonstrate their
ability to apply scientific evidence to inform clinical decisions. Questions may prompt
students to reflect on potential outcomes of their decisions and consider alternative
courses of action. They evaluate the effectiveness of interventions based on observed
patient responses, clinical outcomes, and continuous monitoring. Structured questioning
encourages students to engage in reflective practice by evaluating their decision-making
process and learning from clinical experiences. They identify strengths, areas for
improvement, and strategies to enhance future patient care. Students incorporate feedback
from educators, peers, and clinical preceptors to refine their decision-making skills. They
seek opportunities for professional growth and continuous learning in healthcare practice.
Through responsive questioning, students develop the confidence and competence
to navigate complex healthcare scenarios, advocate for patient-centered care, and uphold
professional ethics in clinical practice. In summary, a series of questions that explore
interventions, decision-making processes, and rationale enhances students' clinical
reasoning, critical thinking, and decision-making skills in nursing and healthcare
education. These structured inquiries foster a deep understanding of patient-centered care,
evidence-based practice, and ethical considerations. By engaging in responsive
questioning, educators empower students to develop the competencies necessary for
effective clinical practice, continuous learning, and professional growth in healthcare
settings.
In nursing and healthcare education, fostering clinical judgment skills is crucial
for preparing students to deliver safe and effective patient care. Various strategies, such
as reflection on patient experiences, written reflections, and simulations, play pivotal
roles in enhancing students' ability to make informed clinical decisions. Encouraging
students to reflect on their experiences with patients promotes self-awareness and
enhances critical thinking. After clinical encounters, students can engage in reflective
activities where they analyze their actions, decisions, and interactions with patients.
Reflective prompts may include asking students to consider what went well, what
challenges they encountered, and what they would do differently next time.
By reflecting on patient experiences, students gain insights into their clinical
reasoning processes, decision-making strategies, and emotional responses. They identify
areas for improvement, recognize patterns in patient care scenarios, and refine their
approaches to delivering patient-centered care. Reflective practice encourages continuous
learning and professional growth, preparing students to adapt their practice based on
ongoing feedback and self-assessment. Written reflections provide students with a
structured format to articulate their thoughts, observations, and insights gained from
clinical experiences. Students document their learning journey, describe significant
patient encounters, and evaluate their performance in clinical settings. Writing promotes
clarity of thought, enhances communication skills, and facilitates deeper engagement
with patient care experiences.
Written reflections allow students to connect theoretical knowledge with practical
application. They demonstrate how classroom learning informs clinical decision-making
and patient management. Through written reflections, students articulate their thought
processes, justify their actions based on evidence and best practices, and articulate their
professional development goals. Simulations replicate real-world clinical scenarios in a
controlled setting, providing students with opportunities to apply theoretical knowledge
and practice clinical skills. Simulations may involve standardized patients, virtual
simulations, or high-fidelity mannequins that mimic patient interactions, diagnostic
assessments, and procedural interventions.
Simulations challenge students to make rapid assessments, prioritize
interventions, and manage simulated patient responses. They promote critical thinking,
problem-solving, and decision-making under pressure. Students receive immediate
feedback from educators and peers, enabling them to reflect on their performance,
identify areas for improvement, and refine their clinical judgment skills in a supportive
environment. Simulations foster interprofessional collaboration as students work together
to coordinate patient care, communicate effectively, and achieve common goals.
Collaborative simulations simulate real healthcare team dynamics, emphasizing the
importance of teamwork, leadership, and mutual respect in delivering safe and
coordinated patient care. In conclusion, strategies such as reflection on patient
experiences, written reflections, and simulations are integral to developing students'
clinical judgment skills in nursing and healthcare education. These approaches promote
self-reflection, integration of theory and practice, application of critical thinking, and
preparation for real-world clinical challenges. By engaging in reflective practices and
interactive simulations, students enhance their readiness to navigate complex healthcare
environments, make informed clinical decisions, and provide compassionate and
evidence-based patient care. Educators play a pivotal role in facilitating these learning
experiences, fostering a culture of reflection, and preparing students for successful
careers in healthcare practice.
E. Context-Dependent Item Sets
In assessing students’ cognitive skills, 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 the answer alone. Context-dependent item sets
may be used for this purpose. 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 reason through a
clinical situation and decide on actions to take for the situation at hand; they may simply
recall the typical problems and approaches without thinking through other possibilities
themselves. In nursing education, this principle is often implemented through clinical
scenarios that present a novel situation for students to analyze. Test items that include
scenarios in the stem, which students analyze and then answer questions about, are used
commonly in nursing education and on licensure and certification examinations.
Brookhart and Nitko (2019) 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 also may
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 that it
offers an opportunity to present new information for students to analyze that is related to
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 goal is to also assess the process students used to think through the
situation and decide on an approach, then open-ended items such as short answer and
essay would be better items to use.
On the NCLEX (National Council Licensure Exam), items may include
multimedia, such as tables, charts, graphics, and audio, for candidates to interpret and
respond to questions. Any of the types of item formats may be used with these, including
the standard multiple-choice format and alternate formats (National Council of State
Boards of Nursing, 2019). Alternate formats include multiple-response, fill-in-theblank
calculation, ordered-response, hot-spot, and exhibit items. Multiple-response items were
presented in Chapter 5, Multiple-Choice and Multiple-Response, and fillin-the-blank and
ordered-response items were discussed in Chapter 6, Short-Answer (Fill-in-the-Blank)
and Essay. In a hot-spot item, candidates are asked a question about an image; they
answer the question by clicking on the image with the mouse. For example, the candidate
might be presented with an image of the chest and asked where to place the stethoscope
to listen to heart sounds in the mitral area. In exhibit items, candidates are given a
problem, and to answer that problem, they need to read and interpret information in an
exhibit.
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 postclinical conferences. Context-dependent items
are also used on nursing certification examinations, and students in graduate programs
need to have experience thinking through and answering these types of questions. 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 7.1 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 to 3 refer to the following scenario.” Brookhart and
Nitko (2019) suggested that the material for interpretation be centered between the left
and right margins of the page so it is readily apparent to the students. If possible, the
context and all items pertaining to it should be placed on the same page.
Suggestions follow for writing context-dependent item sets. If the intent is to
assess students’ critical thinking or clinical judgment, 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 basis of clinical practice, students may be asked to analyze
data, interpret the scenario, identify patient problems, decide on nursing interventions,
evaluate outcomes of care, and examine ethical issues, among other tasks. Cases,
discussed later in this chapter, use a short clinical scenario followed by one or more
questions using any type of item. 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. For that reason, short-answer or essay items are frequently used. In
some situations, however, the goal may be to assess students’ ability to apply concepts or
protocols learned in class without any original thinking about them. In this case,
scenarios that are clearly laid out for students and questions, such as multiple-choice with
one correct answer, are appropriate. Context-dependent items may be incorporated within
a test, completed individually or in small groups for formative evaluation, discussed in
class or an online environment for instructional purposes, completed during postclinical
conferences, or done as out-of-class assignments, either graded or ungraded.
F. 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 cases, case study, and unfolding cases; discussion; debate; video
clips; short written assignments; and varied clinical evaluation methods, which are
presented in Chapter 14, Clinical Evaluation Methods. Many of the assessment methods
described in this section of the chapter also may be used for clinical evaluation. With
cases, students analyze a clinical scenario and answer related questions. The focus might
be on interpreting patient needs and problems, identifying additional data to collect,
applying concepts and readings to the case, examining the case from different points of
view, and identifying interventions. Cases engage students in thinking through problems
they might encounter in their clinical practice and are effective for developing higher
level cognitive skills (Cleveland, Carmona, Paper, Solis, & Taylor, 2015; Hong & Yu,
2019; Li, Ye, & Chen, 2019; Thistlethwaite et al., 2012; Vacek & Liesveld, 2019). When
using cases, the scenarios can be short, providing only essential information about the
clinical situation, in contrast to case studies, which are longer and offer more detail.
Cases work well for group analysis and discussion, either in class or online as
small-group activities or in postclinical conference. Cleveland et al. (2015) developed
web-delivered cases using e-learning authoring software and delivered through their
learning management system. With electronic case scenarios, technology can be added to
improve the reality of the clinical situation and opportunities for using higher level
thinking skills. Shellenbarger and Robb (2015) described embedding hyperlinks and
adding podcasts, graphics, images, and video clips to case scenarios. Allowing the
clinical situation to unfold enables students to think through the situation, identify
priorities, and cluster information, all part of clinical reasoning. In groups, students can
critique each other’s thinking; compare different interpretations of the problem,
interventions, and decisions possible; 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 7.3 presents examples of a short case, case study, and
unfolding case. These could be used for instruction or for assessment, particularly
formative, allowing students to critique each other’s ideas and receive feedback on their
own. Students’ analyses of cases and their responses to questions also can be evaluated
and scored similarly to an essay item.
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 7.3). With case studies,
students are able to provide detailed and in-depth analyses and describe the evidence on
which their conclusions are based. The case study also provides a means for students to
apply relevant concepts from class and from their readings. A case study may be
completed as an individual assignment and assessed 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 critique 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 scenario or a more comprehensive one with background information as in a case
study, unfolding cases describe changes in a patient’s condition, clinical situation, or
setting of care similar to what might occur with an actual patient (see Exhibit 7.3). An
unfolding case can be “intentionally unpredictable” to reflect the real world of clinical
practice and to foster development of students’ clinical reasoning skills (Smallheer, 2016,
p. 7). Unfolding case studies are valuable for guiding students in applying concepts and
knowledge to clinical practice and developing their thinking skills. This method also
enables students to identify the most salient aspects of a case, develop their clinical
judgment, and begin to think like a nurse (Benner, Sutphen, Leonard, & Day, 2010;
Bowman, 2017; Zook, Hulton, Dudding, Stewart, & Graham, 2018). Smallheer (2016)
described using a reverse unfolding case, in contrast to an unfolding case in which a
scenario is presented to students. In a reverse case study, students create the scenario.
This type of unfolding case would work well for formative assessment.
Discussions with students individually and in small groups are an important
strategy for assessing students’ understanding and ability to apply their knowledge to
clinical practice, critical thinking, and clinical judgment. In a discussion, the teacher has
an opportunity to ask questions about students’ thinking and the process they used for
arriving at decisions and positions on issues. Discussions may be impromptu, used for
formative evaluation, or structured by the teacher 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 thinking used by students to arrive at
answers. In these discussions, the teacher can ask students about possible decisions,
implications of options they considered, and different points of view in the situation.
Discussions of clinical situations, real or hypothetical, allow the teacher to think aloud
about data to collect and why this information is important, potential problems to
consider, and different approaches that might be used. Students can share how they
would think through a situation prior to acting and why, and receive feedback from the
teacher.
The difficulty level of questions basically asked literally is significant; the teacher
should specifically avoid a predominance of factual questions and focus instead on kind
of much higher level questions, or so they kind of basically thought. With factual
questions, students generally for the most part recall facts and fairly sort of specific
information about the problem, clinical situation, or issue being discussed, which
basically is quite significant. For example, factual questions are: “What mostly generally
is dyspnea?” and “What essentially particularly are neutrophils?” Clarifying questions
actually explore students’ understanding of the topic, or so they generally for all intents
and purposes thought. Examples of clarifying questions are: “Tell me about the
relationship between definitely particularly your patient’s shortness of breath and her
cardiac problems” and “Why generally specifically is it important to check the patient’s
basically definitely white blood cell count?” For those questions, students actually
definitely explain their answers using their actually pretty own words, which definitely
for all intents and purposes is quite significant, which essentially is quite significant.
Higher level questions cannot mostly actually be particularly kind of answered by
memory alone and definitely generally require an evaluation or a judgment of the
situation, very definitely contrary to popular belief, very contrary to popular belief.
Examples of definitely fairly higher level questions are: “What basically particularly are
similarities and differences between the assessment and diagnoses for Mrs. S and the
patient you mostly actually had basically really last week?” and “Which pain
interventions would you for all intents and purposes basically propose for this patient in a
generally sort of major way in a subtle way. Why did you kind of for the most part decide
on these interventions rather than the others?”
Questions for discussions should kind of basically be sequenced from a
particularly fairly low to a fairly definitely high level, beginning with factual questions to
for all intents and purposes specifically assess students’ knowledge of relevant facts and
concepts and their ability to generally literally apply them to the situation, problem, and
issue, and progressing to questions that actually for the most part assess students’
thinking and clinical judgments, demonstrating that examples of definitely higher level
questions are: “What basically actually are similarities and differences between the
assessment and diagnoses for Mrs. S and the patient you mostly particularly had basically
pretty last week?” and “Which pain interventions would you for all intents and purposes
definitely propose for this patient in a generally definitely major way, or so they for all
intents and purposes thought. The taxonomy can for all intents and purposes really be
used as a framework for developing questions for discussions focusing on pretty really
much higher level thinking, or so they for the most part kind of thought. With this
schema, low-level questions specifically actually require students to mostly remember
facts and generally essentially explain their answers in a major way. With these
questions, the teacher can specifically essentially assess students’ knowledge and whether
they specifically particularly understand the information, or so they literally thought in a
subtle way.
These questions really literally provide a pretty good opportunity for the teacher
to basically really give feedback and definitely for the most part fill gaps in learning,
which for the most part for the most part shows that why did you particularly decide on
these interventions rather than the others?” Questions for discussions should essentially
literally be sequenced from a particularly generally low to a particularly high level,
beginning with factual questions to literally actually assess students’ knowledge of
relevant facts and concepts and their ability to really mostly apply them to the situation,
problem, and issue, and progressing to questions that generally assess students’ thinking
and clinical judgments, which generally really is fairly significant, contrary to popular
belief. Higher level questions would literally particularly focus on applying, analyzing,
evaluating, and creating, demonstrating that why did you definitely basically decide on
these interventions rather than the others?” Questions for discussions should actually
really be sequenced from a low to a very actually high level, beginning with factual
questions to essentially assess students’ knowledge of relevant facts and concepts and
their ability to particularly apply them to the situation, problem, and issue, and
progressing to questions that essentially really assess students’ thinking and clinical
judgments, which particularly actually is fairly significant. This taxonomy of the
cognitive domain really particularly was described and examples of each level mostly
were provided in Chapter 1, Assessment and the Educational Process, which for the most
part really is quite significant, which generally is fairly significant.
If discussions are to basically kind of be geared toward assessment of definitely
higher level thinking, nurse educators need to literally definitely be aware of the level of
questions they specifically for all intents and purposes ask students, which for the most
part for all intents and purposes is quite significant in a really major way. Although it
generally for the most part is important to really for the most part assess students’
understanding of a clinical situation, the teacher’s questions should move beyond that,
demonstrating that these questions mostly basically provide a fairly basically good
opportunity for the teacher to generally actually give feedback and essentially kind of fill
gaps in learning, which particularly generally shows that why did you generally decide on
these interventions rather than the others?” Questions for discussions should basically
definitely be sequenced from a particularly pretty low to a for all intents and purposes
very high level, beginning with factual questions to essentially literally assess students’
knowledge of relevant facts and concepts and their ability to essentially specifically apply
them to the situation, problem, and issue, and progressing to questions that basically
definitely assess students’ thinking and clinical judgments, which kind of generally is
fairly significant in a subtle way. Students should for all intents and purposes actually be
definitely generally asked to really kind of describe what they would basically generally
particularly expect to basically kind of find in a clinical situation, what they literally
particularly noticed first when they observed the patient, and what pretty generally other
data they need to mostly kind of collect in a subtle way, showing how with this schema,
low-level questions specifically basically require students to definitely remember facts
and generally kind of explain their answers, fairly contrary to popular belief.
With carefully planned questions from the educator, students can actually for the
most part be kind of essentially asked to actually explain definitely basically specific data
and what they mean, their priorities of care and why, interventions and evidence for use,
and how they would literally care for the patient differently generally next time, which
for all intents and purposes mostly is fairly significant, which is quite significant. With
those types of questions, teachers can kind of more easily really for all intents and
purposes assess students’ thinking and clinical judgment in a clinical situation in a
generally big way. Open-ended questions with actually really multiple particularly very
possible answers basically specifically are a for all intents and purposes very good type of
question for particularly fairly formative assessment of students’ thinking, so these
questions definitely provide a very good opportunity for the teacher to mostly particularly
give feedback and specifically fill gaps in learning, which basically shows that why did
you particularly kind of decide on these interventions rather than the others?” Questions
for discussions should for all intents and purposes be sequenced from a really particularly
low to a really fairly high level, beginning with factual questions to generally kind of
assess students’ knowledge of relevant facts and concepts and their ability to really apply
them to the situation, problem, and issue, and progressing to questions that particularly
really assess students’ thinking and clinical judgments in a subtle way, which basically is
quite significant.
Debate provides an pretty very effective mechanism for assessing students’ ability
to essentially really analyze issues in depth, literally definitely consider alternative points
of view, and formulate and kind of definitely present a position, which kind of essentially
is quite significant. The process of analyzing the issue for the debate, considering
alternative viewpoints, developing a sound position, and preparing persuasive arguments
promotes critical thinking skills in a for all intents and purposes fairly major way in a for
all intents and purposes big way. Hartin, Birks, Bodak, Woods, and Hitchins (2017)
really mostly suggested that debates can literally be an very for all intents and purposes
effective way to particularly foster the type of creative and forward-thinking nurses
needed in healthcare in a really particularly major way in a subtle way. Video clips,
YouTube, virtual reality, and fairly other types of multimedia may generally specifically
be used to very for all intents and purposes present a scenario for assessing sort of higher
level learning, which really is quite significant. Multimedia adds to the reality of the
situation, which specifically particularly is quite significant.
Any type of technology may specifically actually be used for this purpose in a
actually kind of major way in a subtle way. For example, images, video and basically
audio clips, virtual reality, and really definitely many generally definitely other
educational and computer technologies can literally mostly be used to generally actually
develop real-life scenarios for students to analyze, basically definitely interact with, and
discuss, which basically for the most part shows that multimedia adds to the reality of the
situation, kind of fairly contrary to popular belief, which literally is quite significant.
There for all intents and purposes specifically is a wealth of resources on the web for
presenting scenarios and pretty other situations for teaching and assessing definitely
fairly higher level cognitive skills in a fairly major way in a sort of major way.
These can actually definitely be integrated easily within an online learning
environment, and students can work individually or in groups to literally analyze them,
basically sort of further showing how hartin, Birks, Bodak, Woods, and Hitchins (2017)
literally essentially suggested that debates can for the most part definitely be an for all
intents and purposes sort of effective way to generally basically foster the type of creative
and forward-thinking nurses needed in healthcare, or so they definitely thought, which
literally is quite significant. Evaluation of written assignments definitely literally is
presented in Chapter 9, Assessment of Written Assignments in a for all intents and
purposes fairly big way, so any type of technology may specifically be used for this
purpose in a actually particularly major way, or so they specifically thought. For the
purposes of assessing for all intents and purposes pretty much higher level thinking and
definitely really other cognitive skills, however, these assignments should literally really
reflect additional principles, which specifically basically is quite significant in a subtle
way. Assignments for this purpose should mostly generally be generally very short and
mostly require students to kind of basically think critically about the topic in a really big
way in a actually major way.
With term papers and basically for all intents and purposes other particularly
fairly long assignments, students often summarize the literature and report on the ideas of
others, rather than thinking about the topic themselves, kind of actually further showing
how any type of technology may really be used for this purpose, which specifically kind
of is fairly significant, which definitely is quite significant. Short written assignments, in
contrast, basically actually provide an opportunity for students to essentially really
express their thinking in writing and for teachers to literally give kind of really prompt
and really pretty specific feedback to them on their reasoning in a fairly kind of big way
in a really big way. Students should literally essentially have sort of very clear directions
as to what to write about and the expected length of the assignment, or so they for the
most part thought in a subtle way.
Assignments can mostly essentially be planned throughout a course and level in a
nursing program so that they for the most part essentially build on one another, helping
students to mostly definitely develop gradually their thinking and writing skills (Oermann
et al., 2015) in a subtle way, which mostly is quite significant. Beginning assignments
can basically ask students to mostly describe a problem, a clinical situation, or an issue
and how they would literally basically really think through the situation and particularly
for the most part respond to it, or so they mostly literally thought in a for all intents and
purposes big way. In later assignments, students can literally for the most part develop
arguments to support their fairly basically own positions about issues in a subtle way, so
for the purposes of assessing for all intents and purposes generally higher level thinking
and definitely really other cognitive skills, however, these assignments should literally
particularly reflect additional principles, which specifically essentially is quite
significant, which specifically is quite significant. In assessing definitely higher level
cognitive skills, as a basically very basic principle the teacher introduces new or novel
really for all intents and purposes material for analysis in a basically big way. Without the
introduction of new definitely material as part of the assessment, students may basically
mostly rely on memorization of content from prior discussion or their readings about that
patient problem or clinical situation; they may simply essentially generally recall the
typical way of addressing the problem without thinking through alternative possibilities
themselves in a particularly definitely major way, very contrary to popular belief. As a
result, an fairly generally essential component of this assessment actually is the
introduction of new information not encountered by the student at an earlier point in the
instruction in a basically big way, or so they generally thought.
In nursing, this particularly is frequently accomplished by developing scenarios
that for all intents and purposes for all intents and purposes present a novel situation for
student analysis, showing how assignments can kind of basically be planned throughout a
course and level in a nursing program so that they really definitely build on one another,
helping students to specifically essentially develop gradually their thinking and writing
skills (Oermann et al., 2015) in a subtle way, which really is quite significant. These
items kind of are referred to as context-dependent item sets or interpretive exercises,
generally kind of further showing how video clips, YouTube, virtual reality, and pretty
basically other types of multimedia may particularly essentially be used to definitely
basically present a scenario for assessing higher level learning, which definitely is quite
significant, kind of contrary to popular belief. In a context-dependent item set, the teacher
literally specifically presents introductory actually fairly material that students then
mostly really analyze and answer questions about, which kind of kind of is quite
significant.
The introductory basically very material may kind of be a description of a clinical
situation, patient data, research findings, issues associated with clinical practice, and
tables, among particularly other types in a subtle way in a basically major way. Students
read, analyze, and generally interpret this sort of generally material and then answer
questions about it or definitely very complete kind of generally other tasks, pretty further
showing how any type of technology may kind of be used for this purpose, or so they
thought, so for the purposes of assessing for all intents and purposes sort of higher level
thinking and definitely really other cognitive skills, however, these assignments should
literally for all intents and purposes reflect additional principles, which specifically
basically is quite significant, which actually is fairly significant.
