In exploring my modified posed question “How can learning in nursing be measured cognitively, performatively and affectively?" I need to delve into the current methods of evaluating learning in nursing.
Tanner (2011) looks at various measurement methods utilized across nursing to evaluate nursing education. She calls for an improvement in developing suitable measures for the evaluation of learning outcomes and refers to the situation as a “critical state”.
She identifies three broad categories of learning outcome assessments utilized in nursing education research.
Opinion surveys and self reports are used in simulation labs but create a lot of variation and include a lot of subjectivity. Having used these reports in our Faculty of Nursing, I agree with the author. We do not use the reports for scoring the students, but to critique how we can improve our simulation presentations and scenarios (case studies).
Tanner cites a second means of testing, standardized tests, as likely better than teacher-created exams because the in house “tests frequently lack psychometric evaluation beyond internal consistency reliability and minimal content validation.” She points out that standardized tests “may not be sensitive to variations produced by educational interventions” and gives the example of ”interventions directed toward improving clinical reasoning, such as case-based instruction, may not affect content knowledge scores.”
This points to the necessity to ensure that all aspects of learning leading to critical thinking be addressed (cognitive, affective and performative). Can one assume that content knowledge is part of the cognitive realm?
Tanner suggests that although standardized tests might have a role in testing nursing learning, she criticizes their reliability as a standard for measuring specific nursing performance, such as clinical reasoning, or are sensitive to the style of nursing education interventions.
The third method is clinical skills checklists. We use skills checklists in evaluating performance based nursing skills and include critical thinking skills and questions for cognitive learning measurement and include criteria that involves affective learning such as addressing modesty, confidentiality, respect, sensitive communication and ethics. Tanner suggests there is some value in these methods of measurement.
Tanner holds out great promise for high-fidelity simulation, coupled with rating scales or assessment rubrics to test students’ ability to use relevant knowledge in particular contexts. She addresses the need for multiple scenarios and the constraint of high economic cost of such methods.
This article points to the concern that the current methods utilized in measuring nursing learning are not considered sufficient or comprehensive enough to warrant continued use. Tanner calls for the development of measures that are appropriate for a clinical practice discipline and that will reflect variations in educational approaches.
With my question, I believe this article echoes the concern that there might not be a ready answer to my question!
Reference:
Tanner, C. A. (Ed.)r(2011). The critical state of measurement in nursing education research. Journal of Nursing Education. Vol. 50(9): 491-492. DOI: 10.3928/01484834-20110819-01
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ReplyDeleteBrenda, I agree with you that measuring the various 'human' elements that go into training a nurse is not the easiest to measure.I was wondering if the rubric designed is universal as the expectations or would each teaching approach evoke a unique rubric to measure the cognitive, performative and affective domains. To achieve a particular cognitive domain should they be able to apply the learning practically (perforamtive) and palpate the affect of the task in hand.
ReplyDeleteI am interested to see the process you will choice to take to address your inquiry as it is pretty close to what I am heading with my inquiry.
How can “cognitive, performative and affective learning in nursing education be measured?
ReplyDeleteIn dissecting my question, I discovered that cognitive and performative learning are more easily objectively measured than the affective domain. As per our class discussion, the more subjective a measurement, the less credence it can be afforded. (I recall the arbitrary, subjective, objective continuum Prof Potter drew.) The need to measure affective learning has never been at issue, but how to best measure it has been a subject of intense study.
The University of Minnesota addresses how learning objectives should be stated and in their discussion they point to the importance of including affective domain outcomes. The authors acknowledge that this is challenging and suggest five levels of objectives as proposed by Krathwohl, Bloom, and Masia in 1964:
• Receiving / Attending - willingness to become aware
• Responding - appreciating or internalizing
• Valuing - accepting, preferring, becoming committed to
• Conceptualizing / Organizing - incorporating into a value system
• Characterizing by value - orientation toward / identification with.
In this discussion, the authors confirm the need to list outcomes in action terms, or with verbs and “examples of types of activities indicative of achievement of outcomes related to that level of the domain.” This is the sum of their address of the affective domain in this particular document.
Reference: http://www.nursing.umn.edu/Preceptors/evaluation/Module2/affective/home.html
In her article, Teaching and Learning in the Affective Domain, Mary Miller of the University of Georgia researched the best approaches to instructional design in order to meet affective learning outcomes. She cited Simonson’s and Maushak’s (2001) meta analysis in which they create a series of six guidelines:
• make the instruction realistic, relevant, and technically stimulating
• present new information
• present persuasive messages in a credible manner
• elicit purposeful emotional involvement
• involve the learner in planning, production or delivery of the message
• provide post-instruction discussion or critique opportunities
Miller also cited Smith’s and Ragan’s (1999) three key instructional approaches:
• demonstration of the desired behavior by a respected role model
• practice of the desired behavior, often through role playing
• reinforcement of the desired behavior
Although this does not directly answer how to best measure affective learning, the approaches to learning (assessment tasks), along with the marking rubric and defined learning outcomes, must intersect. This discussion helps to shed light on the affective domain of learning. The “how to” helps to define and accomplish the “what” of affective learning.
Reference: http://projects.coe.uga.edu/epltt/index.php?title=Teaching_and_Learning_in_Affective_Domain
When Anna, you asked about nursing having a universal rubric design, that seems to have been the corporate aim when Canadian level competencies for nursing were recently developed and published. In nursing, the affective domain is measured by the consistency of behaviours that suggest an underlying attitude, such as professionalism or respect or cultural sensitivity. Sadly, that is not to say that public behaviours reflect the true heart of an individual! (some could point to religious hippocrits who slip up when they think no one is looking). I am hoping these references might help to answer your question, Anna (and others!)
In my post earlier this week, Tanner (2011) points to the concern that the current methods utilized in measuring nursing learning are not considered sufficient or comprehensive enough to warrant continued use.
This Minnesota article speaks to affective learning measurement, but reinforces yet again that affective learning cannot be objectively measured.
Next steps... hmm.
Hi Brenda,
ReplyDeleteI enjoyed your post. It appeared to have enthusiasm and excitement embedded within your search for answers and that made reading it, fun. My comments for you this week are a reflection of the overall flavour and I hope you don’t find my comments too “out there”. When I read your blog, my first thought was how WE are really stuck on objective assessment – all of us. We strive to find it. Each time we get closer to subjective assessment, with potential “answers”, we find ways and reasons to justify the need to be objective. Maybe I was reading too much into your words, but I wondered if frustration squashed your enthusiasm with a sense of needing to shift from subjective outcomes to objective outcomes to somehow provide credibility? Why? Is there really objectivity? Is this self deception (Mullaly, 2010)?
Beth
Hi Brenda,
ReplyDeleteYes I think you chose a really tough and important question. As I read your post I kept thinking back to our conversation in class on objectivity and subjectivity. It might be an idea to consider the number of ways in which nursing is cognitively, performatively, and affectively is authentically assessed. This approach may be beneficial in terms of creating convergence towards a more objective assessment of nurses' learning.
You found some interesting information about how nurse educators have evaluated learning. What does that tell you about what they can do? What they should do? Those are the kinds of questions to ask now. Finding the information about what people have already done is the easy part. :)
ReplyDeleteI was a little surprised that you hadn't refined your question in response to the discussion regarding your previous post, as you seemed to agree that what we needed to look at was evaluation rather than measurement. What you write AFTER you pose the question here suggests that you ARE thinking in terms of evaluation now, so I would suggest rephrasing your question to accord with the approach you're taking. Then, in the comment you wrote in response to Anna, you went back to talking about measurement.
Content knowledge would be considered part of the cognitive domain, yes. Think of content knowledge as "knowledge that", declarative knowledge.
The considerations regarding affective learning and assessment (raised in response to Anna) are important, and I'd really like to see what you can do with them. I think that in this and previous posts you've accumulated a lot of information. Now it's time to take the plunge into the next step: reasoning about it, using it, evaluating it -- all in regard to how it can help you answer your question. What these sources tell you is less important than what you can do with that information.
You can do a lot!