Monday, November 5, 2007

This presentation is part of : Research Tool Development
Development of a Composite Cognition Instrument for Nursing Care of Combat Casualties: Pilot Testing
Patricia Frohock Hanes, PhD, MSN, MAEd, RN and Arthur Don Johnson, RN, PhD. School of Nursing, Azusa Pacific University, Azusa, CA, USA
Learning Objective #1: explain the components of the new construct of composite cognition.
Learning Objective #2: articulate the steps in the process of establishing validity and reliability in a criterion-referenced instrument.

Purpose: The aim of this study was to develop the Composite Cognition Instrument for Nursing Care of Combat Casualties (CCI) and evaluate its reliability and validity through review by an expert panel and in a sample of active and reserve duty military registered nurses.

Problem Statement: There is no instrument that measures composite cognition consisting of lower-level cognition, higher-level cognition, and critical thinking related to the care of combat casualties.

Conceptual Frameworks: Bloom’s taxonomy with Krathwohl’s (2002) revised taxonomy and critical thinking theory are the frameworks for this study. Composite cognition, a new construct, consists of three elements: lower-level, higher-level, and critical thinking cognition.

Methods: The CCI measures the three subscales of composite cognition: lower- and higher-level and critical thinking cognition. Seventy-five multiple choice questions were developed based on scenarios using conditions seen in combat: hypovolemic shock, tension pneumothorax, and cardiac tamponade. This criterion-referenced instrument was reviewed by an expert panel to establish item-objective congruence, content validity, and readability. The instrument was administered to 32 military registered nurses using a test-retest method to establish validity and reliability.

Findings: Content validity was established through expert review; congruency percentage was 93%; item-objective congruence was .8026. Test-test reliability was established with a Pearson r of .857. A Kuder-Richardson of .91 established test dependability. Mean item difficulty was .57 on the pre-and post-tests. Point-biserial technique was used to evaluate item discrimination.

Conclusions: The CCI is a valid and reliable instrument with good item discrimination. Further testing is needed with a larger sample. This instrument adds to the body of knowledge for teaching combat casualty care and will be used to evaluate educational approaches for military nurses in caring for injured soldiers and civilians in combat areas.

This project  is supported by a TSNRP grant titled “Educational Intervention on Combat Trauma Care”.