Design: This study uses a non-experimental qualitative method based on talk-aloud protocols and an opinion survey.

Population: Population was a purposeful sample of graduate nurses in their initial year of practice, determined through telephone interview to include ethnically diverse male and female participants.

Variable(s): The outcome variables were level of cognitive processing used to answer items and opinions regarding alternate item formats versus MCQs.

Methods: Participants were asked to talk out loud while answering items and their talking was tape recorded and then transcribed. An analysis of nurse experts’ rating the talk alouds was conducted using the multifaceted Rasch measurement model (FACETS), providing indications of the consistency of raters and the reliability of items to separate the people.

Findings: Results show that the raters and items are reliably separating the participants. Survey results revealed that for all item types, 79% of the participants agreed or strongly agreed that the items using alternate formats were more realistic and allowed them to demonstrate their competence better than MCQs.

Conclusions: Some alternate item formats require more complex cognitive processing than a paired MCQ and allow assessment of competencies not currently being assessed. An unanticipated confounding variable was the difficulty of the item and the level of knowledge of the participant.

Implications: Assessment of critical thinking skills on the licensure examination indicates this aspect of entry-level nursing has been assessed. Upon identifying the ability to test higher cognitive processes, it would be incumbent upon educational programs to encourage nursing students to further develop this ability and translate it into practice.

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Back to 15th International Nursing Research Congress
Sigma Theta Tau International
July 22-24, 2004