Nursing Education and Learning Outcomes of Diverse Students & Assessment
Assessing the Learning Outcomes of Diverse Students In Nursing
Nurse educators have a responsibility to prepare students to successfully meet established learning outcomes and achieve licensure. Faculty use a variety of methods to assess learning outcomes such as mind maps, simulation events and demonstration, essays and reflective writing, and presentations.
By far the most used assessment technique is objective and standardized testing. Entire course grades, progression, and graduation are based solely on results of objective or standardized exams. These “high-stakes tests” are defined by the American Education Research Association (2014) as tests that have significant consequences for the test takers, curricula, or institution.
Nurse educators
therefore must adopt a thoughtful approach to test development and guidelines
surrounding standardized test use and the effect these exams have on all
students who must take them.
Use of High Stakes Testing In Nursing Education
There is abundant use of high stakes testing in nursing curricula. High-stakes exams in nursing have several defining characteristics:
(1) they hold students, schools, and programs accountable by virtue of serious consequences for failure
(2) there is a clear distinction between pass and fail
(3) test takers have a vested personal, monetary, or emotional interest in the exam outcome (Sullivan, 2014).
High stakes tests are designed to measure curricular
strengths and weaknesses, as well as students' preparedness for the National
Council Licensure Examination (NCLEX), and to provide recommendations for
students' remediation. These exams provide critical information to schools of
nursing where the first-time test taker rate is used as an outcome indicator of
program quality and effectiveness by state boards and the public.
Literature on the ability of these exit tests to reliably predict student success or failure on NCLEX is prolific and not without controversy (Harding, 2010; Santo, Frander, & Hawkins, 2013).
Faculty in nursing programs have implemented progression and remediation policies that use these exit exams as benchmarks that affect a student's eligibility for graduation and taking the licensure exam. There are also legal and ethical concerns with administration of a single high-stakes, predictive test that may restrict a student from completing a program and licensing by exam (Santo et al., 2013).
As a result, the NLN has
published a document to guide faculty in their decision making with regard to
high-stakes testing and the policies generated (National League for Nursing,
2012b). See Chapter 3 for a further discussion of the possible legal and
ethical issues associated with high-stakes testing.
How the use of high-stakes tests and the policies associated with them can affect diverse students in nursing programs has not been extensively studied. A review of the literature related to English as an Additional Language (EAL) or English language learner nursing students included 25 articles citing cultural, language, and academic barriers to success for these students (Olson, 2012).
Specific barriers include reading speed and translation (Amaro, Abriam Yago,
& Yoder, 2006), lack of faculty cultural awareness (Starr, 2009), and use
of grammar and language in multiple choice test questions (Bosher & Bowles,
2008; Lamp & Tsaouse, 2010).
Faculty are challenged to incorporate strategies to promote student success on high stakes exams by reducing barriers that inherently exist within a diverse student body. The literature suggests a number of strategies that students and faculty may employ to encourage success in students of diverse cultural, racial, and ethnic backgrounds.
EAL students should be encouraged to keep vocabulary cards, to access native English and medical dictionaries regularly, to study in mixed (native speaker and EAL) groups, and to practice explaining the information in their native language (Coddington & Karsten, 2014; Hansen & Beaver, 2012).
Faculty can also provide copies of lecture slides
and class notes, and can allow audiotaping of lectures (Sanner & Wilson,
2008). Early identification of EAL students for referral to language support
programs and tutoring is also essential.
Several studies have demonstrated success building test taking skills of under represented minorities through the use of peer and faculty tutorial support as well as supplemental instruction (Brown & Marshall, 2008; Sutherland, Hamilton, & Goodman, 2007; Swinney & Dobal, 2008 ).
Providing EAL students an alternative testing environment as a way to reduce anxiety is also recommended (Abel, 2009) as EAL students often require extended testing time for reading and processing test items (Caputi, Engelmann, & Stasinopoulos, 2006).
Encouraging students to practice many multiple choice test items
throughout the program and teaching students how to read and analyze items is
critical to success (Lujan, 2008).
Testing bias also affects a student's ability to perform well on an exam. Testing bias occurs when a test or items on a test are “not readily understood by all cultural groups” (Dudas, 2011).
It is incumbent on faculty to write and review
exam questions to ensure they are free of cultural, structural, and linguistic
bias (Bosher & Bowles, 2008; Hicks, 2011). One study of 664 items revealed
a 47.3% rate of flawed test items on teacher-made, high stakes assessments
(Tarrant & Ware, 2008). Please see Chapter 24 for further information on
item and test construction.
“Learning to Fly” Preparing Diverse Learners for Practice Nursing Students
The transition from education to practice is fraught with challenges for the new graduate. New graduates are faced with integrating their “anticipatory socialization” experience, the perceived expectations of their new role, into the reality of “organizational socialization” (Scott, Engelke, & Swanson, 2008, p. 76) in other words, what actually occurs on the job.
New graduates report increased work stress caused by feelings of inability to prioritize, delegate, and manage care of a group of patients; inadequate staffing; and a lack of communication and collaboration skills with physicians (Lin, Viscardi, & McHugh, 2014).
Surprisingly little literature exists about the transition to practice experience of the minority new graduate. Since The Sullivan Commission (2004) on the contribution of a diverse workforce was published, there has been little progress toward increasing diversity in nursing to reflect the population.
This may in part be due to a decline in the funding of the Title VII Nursing Workforce Development Grants Program, a government program designed to address these same goals (American Association of Colleges of Nursing, 2014d).
In one descriptive study of 111 Latino and Latina nurses, fewer than 20% of whom were described as novice or beginners, 74% of the participants reported they had experienced bias in the workplace (Moceri, 2012).
Recent work from the National Council State Board of Nursing on the Transition to Practice Model development indicates that employers report new graduates are not ready to practice (Spector & Echternacht, 2010) and that there is a widening gap between experienced nurses and new graduates (Orsolini Hain & Malone, 2007).
The efforts of the AACN, the Robert Wood Johnson Foundation, and other
private funding sources are vital to the continued support of diverse student
recruitment and retention.
Benner et al. (2010) recommend developing clinical residencies for all new graduates. Transition to practice residency programs are extended (6 months to 1 year) formal and informal learning opportunities focused on developing the new nurses' understanding of policy, standards, and structures of the work environment.
The residency should include time for reflection and connection with other professionals as well as an extension of communication, confidence, and critical thinking competencies (Bleich, 2012). Models of transition programs exist in a partnership created by the AACN and the University Health System Consortium.
The model incorporates five modules based on the IOM and Quality Safety in Nursing Education competencies and incorporates preceptor as well as classroom experiences (Spector & Echternacht, 2010).
Further recommendations to specifically address issues affecting new graduates of color include the promotion of nonbiased interactions in communication as well as inclusion of discussions about cultural sensitivity and perceived language bias among staff and other disciplines (Moceri, 2012).
A program at Coppin State University pairs students with professional nurses in a workplace mentoring situation, providing students with real-world exposure to the nursing profession (Gordon & Copes, 2010).
This chapter describes the demographic characteristics of the current population of nursing students and the unique needs of students from varied generations, men in nursing, and students who are not in the racial or ethnic majority in their classrooms.
The chapter also provides information related to understanding learning styles and the cognitive abilities of students. Faculty are responsible for creating an environment that is conducive to learning. Likewise, students are responsible for identifying environments that will best help them to learn.
Understanding students' diverse learning needs will help faculty and students develop collaborative partnerships that will foster the acquisition of the attitudes, knowledge, and skills necessary to become a nurse.
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