Nursing Education Assessment Tools

EVALUATION AND ASSESSMENT
IN NURSING EDUCATION
Part - 03
Mrs. Babitha K Devu
Assistant Professor
SMVD College of Nursing

Assessment Methods
& Tools
B. Assessment of Attitude
Teachers have always watched and observed students in
the classroom and they have made instructional
decisions based on these observations. Observations
can take place in a variety of settings. They can focus
on student performance during a single activity or
during routine classroom activities.
After deciding what to observe, when to observe, and how
often to observe, teachers will need to plan how to
record their observations. Observations which go
unrecorded in some way will not be as easily defensible
to students, parents, and administrators,
and may be forgotten over time.

Assessment Methods
& Tools
Attitude is the bridge between knowledge and
practice. Thus assessment of attitude becomes an
integral part of student evaluation. The
assessment of attitude is essentially by
observation of verbal and nonverbal behaviour of
the student and is likely to be very subjective.
However the development of various attitude
scales has reduced its subjectivity.
Educators look and listen as they
move through each day, in an effort
to gather as much significant
observational data as possible.

Assessment Methods
& Tools
Techniques For Attitude Measurement:
Behavioral
Techniques
Psychological
Techniques

Assessment Methods
& Tools
Techniques For Attitude Measurement:
Behavioral Techniques:
In these techniques the evaluator try to assess the
attitude of the student on account of his/her day
to day behavior. Most commonly used techniques
under this type are:
Anecdotal records,
Personal records,
Cumulative records,
Group discussion,
Process recording

Assessment Methods
& Tools
Anecdotal records: An anecdotal record (or anecdote) is
like a short story that educators use to record a
significant incident that they have observed. Anecdotal
notes are used to record specific observations of
individual student behaviors, skills and attitudes as
they relate to the outcomes in the program of studies.
Such notes provide cumulative information on student
learning and direction for further
instruction. Anecdotal notes are often written as the
result of ongoing observations during the lessons but
may also be written in response to a product or
performance the student has completed.
Every behavior can’t be recorded, only which reflect some
significance can be recorded.

Assessment Methods
& Tools
Anecdotal records: Notes taken during or
immediately following an activity are generally
the most accurate. Anecdotal notes for a
particular student can be periodically shared
with that student or be shared at the student’s
request. They can also be shared with students
and parents at parent–teacher–student
conferences.

Assessment Methods
& Tools
Anecdotal records:
Characteristics –
• A factual description of an event in which:-
i. How it occurred,
ii.When it occurred,
iii.Under what circumstances it occurred,
iv.The treatment
• Each anecdotal should be of one incident
• Being positive and objective
• Use descriptive language

Assessment Methods
& Tools
Anecdotal records:
PURPOSES:-
1) To stimulate teachers to look for information i.e. to
help student in self-adjustment.
2) The teacher is able to understand her pupil in realistic
manner.
3) It provides healthy pupil-teacher relationship.
4) Helps the student to improve in their behavior, as it is a
direct feedback of an entire observed incident.
5) Can be used by students for self appraisal and peer
assessment.

Assessment Methods
& Tools
Anecdotal records:
Tips for Establishing and Maintaining Anecdotal
Notes
• Keep a binder with a separate page for each student.
Record observations using a clipboard and sticky notes.
Write the date and the student’s name on each sticky
note. Following the note taking, place individual sticky
notes on the page reserved for that student in the
binder.
• Keep a binder with dividers for each student and blank
pages to note down notes. The pages may be divided
into three columns: Date, Observation and Action Plan.

Assessment Methods
& Tools
Anecdotal records:
Notes
• Keep a class list in the front of the binder and check off
each student's name as anecdotal notes are added to
their section of the binder. This provides a quick
reference of the students you have observed and how
frequently you have observed them.
• Keep notes brief and focused (usually no more than a
few sentences or phrases).
• Note the context and any comments or questions for
follow-up.

Assessment Methods
& Tools
Anecdotal records:
Tips for Establishing and Maintaining
Anecdotal Notes
• Keep comments objective. Make specific
comments about student strengths, especially after
several observations have been recorded and a
pattern has been observed.
• Record as the observations are being made, or as
soon after as possible, so recollections will be
accurate.
• Record comments regularly, if possible.

Assessment Methods
& Tools
Anecdotal records:
Notes
• Record at different times and during different activities
to develop a balanced profile of student mathematics
learning.
• Review records frequently to ensure that notes are being
made on each student regularly and summarize
information related to trends in students' learning.
• Share anecdotal notes with students and parents at
conferences.

Assessment Methods
& Tools
Anecdotal records:
ADVANTAGES:-
1) Provision of insight into total behavioral
incidents.
2) Use of formative feedback.
3) Economical and easy to develop.
4) Needs no special training.

Assessment Methods
& Tools
Anecdotal records:
DISADVANTAGES:-
1) If careless recorded, the purpose will not be
fulfilled.
2) Subjectivity.
3) Lack of standardization.
4) Difficulty in scoring.
5) Time consuming

Assessment Methods
& Tools
Cumulative records:
Comparing to the progress records and personal
records of the students, cumulative records are
much comprehensive. Other than the academic
progress of the student they also give information
regarding intelligence, personality, aptitude,
interests, attitude, values, emotional maturity
and conflicts, or self – adjustment, etc. The
interpretation of this record is subjective and
difficult to an extent.

Assessment Methods
& Tools
Process recording:
The verbatim serial reproduction of the verbal
and nonverbal communications between two
individuals for the purpose of assessing
interactions on a continuum leading towards
mutual understanding and interpersonal
relationships.
The evaluative approach is directed towards the
learner’s behaviors in interaction with the others.

Assessment Methods
& Tools
Psychological Techniques:
Likert Scale/Summative Scale:
Various kinds of rating scales have been developed
to measure attitudes directly. The most widely used
is the Likert Scale. The scale is named after its
inventor, psychologist Dr. Rensis Likert (1932)
measure the attitudes by asking people to respond to
a series of statements about a topic, in terms of the
extent to which they agree with them, and so
tapping into the cognitive and affective components
of attitudes.

Assessment Methods
& Tools
• Likert-type or frequency scales use fixed choice
response formats and are designed to measure
attitudes or opinions (Bowling, 1997; Burns, &
Grove, 1997). These ordinal scales measure levels of
agreement/disagreement.
• In it final form, the Likert Scale is a five (or seven)
point scale which is used to allow the individual to
express how much they agree or disagree with a
particular statement.

Assessment Methods
& Tools
Uses:
a) Basically used to measure the attitudes, values and
feelings of the people.
b) To have a quantified measurement of the qualitative
attributes of the people.
c) To assess the option of the people.

Assessment Methods
& Tools
Characteristics:
i. Psychological measurement tool
ii. Illustrative in nature
iii. Neutral statement
iv. Bipolar scaling methods
v. Measurement of the specific number
of scaling categories

Assessment Methods
& Tools
Guidelines For The Construction of Likert Scales
 A five point or seven point scale may be designed with
appropriate degrees of agreement & disagreement
phrases.
 The statement should be brief, concise and precise.
 Each statement should convey only one idea.
 Care should be take about language.
 Statement should be such that they can be
agreed/disagreed.

Assessment Methods
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ADVANTAGES:
• Easy to construct & administer
• Less time consuming
• More reliable & valid tool to measure psychosocial variables
DISADVANTAGES:
 The respondent may feel force to answer and the attitude may
not be fully assessed due to preplanned statements.
 Casual Approach of the respondents may provide misleading
data.

Assessment Methods
& Tools
Semantic Differential Scale –
It is one of the most effective and widely used technique.
In 1967 Osgood, Suci and Tannenbaum introduced
this method. Although the original purpose was not
to assess attitude but was well adopted for attitude
assessment.
This consists of a series of contrasting adjective pairs
listed on opposite ends of a bipolar scale.

Assessment Methods
& Tools
Definition
It is a type of rating scale designed to measure the
connotative meaning of objects, events and concepts.
Theses connotations are used to derive the attitude of
the objects, events and concepts.

Assessment Methods
& Tools

Assessment Methods
& Tools
C. Assessment of Skills
Knowledge is tested in theory examination and skills
are evaluated in clinical or practical examination.
Various methods of skill assessment include:
1. Traditional practical examinations
2. Observed checklists
3. Rating scale
4. Viva voce
5. OSCE/OSPE

Assessment Methods
& Tools
Any of this methods independently cannot
assess the skills of the students with good
validity, objectivity and reliability. So a wise
combination of these tools is mandatory for a
holistic and comprehensive skill assessment
among health professionals.

Assessment Methods
& Tools
1. Traditional or Conventional Practical
Examination
It is concerned with the assessment of practical
performance skill and practice competency
acquired by a student during the course of a
particular programme. They are conducted in
the practice laboratories or real – life practice
areas such as IPDs. It is used to make judgment
on not only skills, but all three domains
including knowledge, attitude, IPR and skills.

Assessment Methods
& Tools
1. Traditional Practical Examination
PURPOSES
* To assess the practical skills and practice
competencies of nursing students.
* To assess the practice domain by observing students
reactions to real – life or simulated situations.
* To assess the student's problem solving skills.
* To assess the documentation skills.
* To assess the skill of transforming theoretical
knowledge in practice by the student.

Assessment Methods
& Tools
Examination
GUIDELINES FOR CONDUCTING:-
A. Planning Phase
 Consider the learning experience and learning
objectives.
 Decide the appropriate place.
 Plan to conduct in a familiar place for students.
 Arrange for adequate supply to carry out
procedure.
 Take prior permission and initiate to concerned
areas.
 The evaluation criteria must be planned and
intimated to the students.

Assessment Methods
& Tools
Examination
GUIDELINES FOR CONDUCTING:-
B. Conducting Phase
 Reach the area as per planned schedule.
 Convey rules and regulations of the
examinations and assign patients randomly.
 Provide sufficient time to perform
 Follow confidentiality.

Assessment Methods
& Tools
Examination
ADVANTAGES:
Provides an opportunity to assess the skills and
competency of the students.
It is an opportunity to the examiners for
assessing the use of compartmentalized
knowledge in an integrated manner by a
student.
For assessing the communication and IPR skills.

Assessment Methods
& Tools
Examination
DISADVANTAGES:
Time consuming process.
Not feasible for large group assessment.
Sometimes the disturbance factors in ward affect
the smooth conduction of examinations.
Not considered a standardized assessment when
conducting while working with patients and
personal bias is expected.

Assessment Methods
& Tools
It is an approach to monitor performance of
specific skills, behaviors, or dispositions of
individual student. Checklist is basically a
method of recording whether a characteristic
is present or an action is performed.

Assessment Methods
& Tools
Definition:
A checklist is a simple instrument consisting of
prepared list of expected items of
performance or attributes, which are checked
by a evaluator for their presence or absence.
A checklist enables the observer to note whether
or not a trait or characteristics is present.

Assessment Methods
& Tools
Characteristics:
Can be used for formative assessments by focusing on
performance of specific skills such as writing skills,
speaking skills or action-based skills.
Should be carefully prepared and must include all
important elements of a specific task that student
must know or perform.
Each element should be sequentially and carefully
included and adequate weightage should be given.
Observe one at a time and use only when assessing a
particular characteristics.

Assessment Methods
& Tools
Guidelines to Construct:
Express each item in clear, specific, observable and in simple
language.
Items can be continuous or divided into groups of related items.
The items created has to be evaluated by the experts.
Avoid negative statements.
Ensure that each item has a clear response.
Review the items independently.
It must be complete and comprehensive in nature.
Leave space to record anecdotal notes or comments.
Each element should be marked as Present/Absent,
inappropriately done and an option “not applicable” can be

Sample Observational Checklist
S.N
o
Items/Elements Done Not
Done
Inappro.
Done
N
A
1. Wash hands
2. Review manufacturers
instructions
3. Explain procedure to patients
4. Selection of hands
5. Removal of nail polish and
cleaning of finger
Checklist for Pulse Oximetry

Assessment Methods
& Tools
Advantages:
Useful in evaluating performance skills that
can be divided into a series of specific actions.
Allow inter-individual comparisons.
It is simple to use and record.
Decreases the error chances.
Useful for evaluating activities which has to
be performed.

Assessment Methods
& Tools
Disadvantages:
Usefulness is limited as it does not indicate
quality of performance and can’t do overall
clinical performance.
The degree of accuracy of performance is limited
if presence or absence is used only as an
attribute.
It has limited use in qualitative observations.
Not easy to prepare.

Assessment Methods
& Tools
3. Rating Scale
It is a term used to express opinion or judgment
regarding some performance of a person, object,
situation and character.
Rating scale is an important technique of
evaluation. Rating is the assessments of a person
by another person. This is one of the oldest
methods of personality assessment. There are
certain general approaches to assess personality
like holistic or overall approach, projective test
approach and trait approach.

Assessment Methods
& Tools
3. Rating Scale
Definition:
It refers to a scale with a set of opinion, which
describes varying degree of the dimensions of
an attitude or a phenomenon being observed.

Assessment Methods
& Tools
3. Rating Scale
TYPES:
(a)Graphic rating scale:
(b)Descriptive rating scale:
(c)Numerical rating scale:
(d)Comparative rating scale:

Assessment Methods
& Tools
3. Rating Scale
TYPES:
(a)Graphic rating scale:
A straight line, may be
represented by
descriptive phrases at
various points. To rate
the subject for a
particular trait a check
mark is made at the
particular point.

Assessment Methods
& Tools
3. Rating Scale
TYPES:
(b)Descriptive rating scale:
This type does not use numbers but divides the
assessment into a series of verbal phrases to
indicate the level of performance.

Assessment Methods
& Tools
3. Rating Scale
TYPES:
(c) Numerical rating scale:
In which numbers are assigned to each trait. If it is a seven
point scale, the number 7 represents the maximum
amount of that trait in the individual, and 4 represents
the average. The rater merely enters the appropriate
number after each name to indicate judgment of the
person.

Assessment Methods
& Tools
3. Rating Scale
TYPES:
(d)Comparative rating
scale:
In this person makes a
judgment about an
attire/attitude/object
by comparing it with
others/ranking it.

ACTIVITY:
HOW FAR
DO YOU
UNDERSTAND
SUBJECTS
IN NURSING?

Assessment Methods
& Tools
3. Rating Scale
CHARACTERISTICS OF RATING SCALE:
• These are value judgments about attributes of one
person by another person.
• These are most commonly used tools to carry out
structured observations.
• These are generally developed to make qualitative
judgment about qualitative attributes.
• Provide more flexibility to judge the level of
performance.

Assessment Methods
& Tools
3. Rating Scale
PRINCIPLES OF RATING SCALE:
 It relates to learning objective.
 Needs to be confined to performance areas that can be
observed.
 Clearly defines mode of behaviour.
 The behaviour should be readily observed in a number of
situations.
 Allow some space in the rating scale for the rater to give
supplementary remarks.
 3 to 7 rating positions may be provided.
 All raters should be oriented to the specific scale as well as
the process of rating in general.

Assessment Methods
& Tools
3. Rating Scale
PRINCIPLES OF RATING SCALE:
The rater should be unbiased and trained.
Consider evaluation setting, feedback and
student participation.
Have experts and well informed raters.
Change the ends of scale so that good is not
always at the top or bottom.
Assure that rater autonomy will be maintained.

Assessment Methods
& Tools
3. Rating Scale
ADVANTAGES:
• Easy to administer and score.
• Its easy to make and less time consuming.
• Easily used for large group.
• Also used for quantitative methods.
• May also be used for assessment of interest,
attitude, personal characteristics.
• Used to evaluate performance and skills.

Assessment Methods
& Tools
3. Rating Scale
DISADVANTAGES:
• Difficult to fix up rating.
• Chances for subjective evaluation, thus the
scales may become unscientific.

Assessment Methods
& Tools
4. OSCE/OSPE
It is a modern type of examination often used in
various professional disciplines including
nursing. An OSCE is designed to test clinical
skill performance such as communication,
clinical examination, nursing procedure by a
student in clinical area where the student is
asked to perform a particular task on a
patient and is evaluated by the examiner.

Assessment Methods
& Tools
4. OSCE/OSPE
An OSPE is designed to assess competence in skill
performance such as chemical analysis, identification
of equipment and interpretation of results, etc. at
different stations in a lab set up.
OSCE/OSPE is designed to overcome the deficiencies in
the traditional practical examination. The method of
assessment is more objective because each complex
clinical competency is broken down into smaller
components. This leads to better sampling of the
clinical skills to be tested and improves the validity of
OSCE/OSPE.

Assessment Methods
& Tools
4. OSCE/OSPE
All students are tested for the same competencies
and all students are provided with the same
duration of time. In this method predetermined
decisions are made on the competencies to be
tested and checklists are prepared to evaluate
important skills.
Scoring of a particular competency is done by same
examiner for all students. These modifications in
the clinical examination improve its validity and
reliability.

Assessment Methods
& Tools
4. OSCE/OSPE
MEANING:
Objective : All students are assessed on same skills at each
stations with the same marking scheme. Here examiners
use a checklist for evaluating the trainees. Hence it is more
objective.
Structured: Both has a better sampling from all elements
of the curriculum and the trainee sees the same problem
and performs the same tasks in the same time frame. Clear
instructions has to be given to avoid any confusion or delay.
Clinical/Practical: The tasks are representative of those
faced in real clinical situations to assess the clinical or
practical skills. The students are asked to response to only
the questions or scenario which is given in each station.

Assessment Methods
& Tools
4. OSCE/OSPE
An earlier innovation in this regard is the objective
structured clinical examination (OSCE) later
extended to the practical examination (OSPE)
described in 1975 and in greater detail in 1979 by
Harden and his group from Dundee. This method
with some modifications has stood the test of time
and has largely overcome the problems of the
conventional clinical examinations mentioned
earlier. Unfortunately, the method is still used very
rarely and that too only for formative evaluation in
our country except for the AIIMS, New Delhi, where
it forms part of the summative evaluation for
students.

Assessment Methods
& Tools
4. OSCE/OSPE
Definition:
The OSCE is an approach to the assessment of
clinical competence in which the components of
competence are assessed in a planned or
structured way with attention being paid to the
objectivity of the examination.
_____ Dr. Harden

Assessment Methods
& Tools
4. OSCE/OSPE
Definition:
The OSPE is a method of practical examination,
assessment tool where subjects and materials
are used instead of patients in a lab instead of
a real life situation.

Assessment Methods
& Tools
4. OSCE/OSPE
Purpose
Problems in routine clinical examination are:
• Variability
• Global assessment
• Marks awarded by overall impression
• Many abilities are ignored
• Difficulty in terms of time, money and number of
patients and examiners required
• Tests the product not the process
OSCE is designed to overcome these deficiencies

Assessment Methods
& Tools
4. OSCE/OSPE
COMPONENTS ASSESSED
Various components of clinical competence are
assessed using OSCE, – For example, the components
of advance clinical nursing practice skills typically
assessed by OSCE are…
1. Interpersonal and communication skills
2. History taking skills
3. Physical examination of specific body system
4. Mental health assessment

Assessment Methods
& Tools
4. OSCE/OSPE
COMPONENTS ASSESSED
5. Clinical decision making including the information of
differential diagnosis
6. Interpretation of clinical findings and investigations,
management of a clinical situation including treatment
and referral
7. Patient education
8. Health promotion
9. Clinical problem solving skills
10. Acting safely and appropriately in an urgent clinical
situation
11. Critical thinking in therapeutic management

Assessment Methods
& Tools
4. OSCE/OSPE

Assessment Methods
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4. OSCE/OSPE
The OSCE examination consists of about 15-20
stations each of which requires about 4-5 minutes
of time. All stations should be capable of being
completed in the same time. The students are
rotated through all stations and have to move to
the next station at the signal. Since the stations
are generally independent students can start at
any of the procedure stations and complete the
cycle. Thus, using 15 stations of 4 minutes each, 15
students can complete the examination within 1
hour. Each station is designed to test a
component of clinical competence.

Assessment Methods
& Tools
4. OSCE/OSPE
About 30 seconds is kept for moving to the next
station. When there are many number of stations
two rest stations can be placed in between to give
students a chance to organize their thought.
Instructions related to OSCE/OSPE should be
given to the students in advance.
Couplet & Double Station: Some competencies may
best be assessed by coupled or linked stations. For
example, a couplet station may consist of a
history- physical examination combined with a
problem-solving station.

Assessment Methods
& Tools
4. OSCE/OSPE
STATION : TWO TYPES
PROCEDURE STATIONS
e.g. Taking history of a patient
Examine eye of a patient
RESPONSE/QUESTION
STATIONS
•MCQs related to finding
•Interpretation of lab report etc.

Assessment Methods
& Tools
4. OSCE/OSPE - STEPS
Identify the
task/skills to
be observed
Arrangement
of stations
Preparation of
checklist
Instruction to
the candidates
Administration
of OSCE/OSPE
Feedback from
candidates
and examiners
Validation &
Item analysis
Question Bank

Assessment Methods
& Tools
The examination will measure objectively the
competencies based on the objectives of the
course or the requirement of the licensing
body.
Example:-
Domain – Knowledge, Psychomotor
Skill – Elicit signs of Anemia
Identify the task/skills to be observed

Assessment Methods
& ToolsC. Assessment of Skills
Instructions for station set-up
• List the equipments required for the station
• Instructions or questions to be performed by the
candidate
• Materials -Table/chair/couch and other materials
as required for the task
• Patient or subject
• An assessor or examiner
• Time frame and changing signal
Arrangement of stations

Assessment Methods
& Tools
Once the tasks are finalized at each station,
checklists, questions, answer keys and
response sheets have to be prepared.
Patients or simulated patients have to be
selected and briefed about their role at the
particular station. Each member in the
examination team has to be made clear about
their roles.
The venue has to be prepared.
Arrangement of stations

Assessment Methods
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The checklist should be complete and include
the main components.
Any unnecessary or exaggerated term must be
avoided.
At all such stations there are observers with
agreed check lists to score the student's
performance. Weightage for each item in the
check list can be decided by the examiners
depending on their importance.
Preparation of checklist

Assessment Methods
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The candidates have to be informed prior
regarding the format and evaluation methods
used in the examination.
Instruction to the candidates

Assessment Methods
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There should not be any means of contact
between the students who have completed and
those who are waiting. There should be only
one entry and exit to access the OSCE/OSPE
stations.
Ensuring confidentiality throughout the process
is mandatory.
Administration of OSCE/OSPE

Assessment Methods
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Feedback from candidates and examiners
Validation & Item Analysis
Question bank

Assessment Methods
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Advantages:
More valid, reliable and objective
Test not only skills and knowledge but attitudes also
Test the student’s ability to integrate knowledge, clinical
skills and communication with the patient
Can be used with large number of students in less time
Reproducible
Provides unique programmatic evaluation
Less complexity
Valid examination
Summative and well formative

Assessment Methods
& Tools
Disadvantages:
Development and administration are time
consuming and costly
OSCE involves lots of planning
The assessment of skills tends to get
compartmentalized in an OSCE, holistic approach
is not there (this can be overcome by combining
OSCE with conventional practical examination
which is called as semi-objective structured
practical examination {SOSPE})

Assessment Methods
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Disadvantages:
The reliability of OSCEs has been found to be low
if there are a small number of stations, noisy
environments, untrained patients and lack of
structured checklists
Need for standardization of simulated patients
and examiner
Repetitive and boring so can create
uncooperativeness
Needs more man power, planning and resources

Assessment Methods
& Tools
Conclusion:
Educational assessment is concerned with the
achievements of educational objectives at the end
of the course. A quality assessment gives feedback
to the students, parents and teachers. Assessment
findings have very important role in curriculum
revision.
Assessment can be classified into formative and
summative assessment. Students should always
be evaluated on all three educational domains of
knowledge, attitude and skill. Selection of
appropriate tool and its quality are vital in
assessment. The tool selected should be of good
validity, reliable, objective and feasible.
Thus wise selection, construction, administration
and scoring of the test by a teacher is the integral
steps of accurate assessment.

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