NRS 107 – Nursing I – Fall 2011
Student Learning Outcomes Assessment Team (SLOAT) Final Report
Prof. Gale Gage
Introduction
NRS 107 is the first nursing course offered that is required for the AAS degree in Nursing offered by
Essex County College. In this course, students are introduced to the basic concepts of professional
nursing that lay the foundation for all subsequent nursing courses required in the program. Content
related to the role of the health care provider is developed in NRS 107, while the basic physiologic and
higher-level needs of mostly elderly clients are also emphasized. Subsumed within the health care
provider’s role are the professional standards expected of a Registered Nurse as outlined by state
licensure standards, NLNAC accreditation, The Joint Commission (TJC), and the American Nurse
Association (ANA).
NRS 107 consists of theoretical, college laboratory, and clinical components that are designed to work
together in order for students to synthesize all aspects of material covered in the course. More
precisely, theoretical principles and standards that guide the practice of nursing are taught, and the
laboratory and clinical activities that are specified in the NRS 107 course outline allow students to apply
these principles and standards to the performance of nursing care.
Purpose
The purpose of this SLOAT study was to determine to what extent the students enrolled in NRS 107 are
able to achieve the course goals listed below.
1. Course Goal # 5: Demonstrate basic nursing skills and the use of current technology in a safe,
competent and caring manner.
2. Course Goal #10: Identify legal and ethical parameters of nursing practice.
Student achievement of these course goals should, in turn, lead to achievement of several of the
Nursing (AAS) program goals.
Methodology
Since only one section of NRS 107 was offered in Fall 2011, all 22 students enrolled in that class made up
the data collection cohort used in this assessment study. Student learning outcomes assessment
NRS 107 – 1
methods used in the study – laboratory skills assessment and blueprinted test questions – were direct,
quantitative, both formative and summative, and both subjective and objective.
Laboratory Skills Assessment – Students must earn a “Pass” on the checklist rubric (see Appendix A of
this report) for each of the critical nursing skills tested. These skills include checking vital signs,
administering medication, and caring for wounds. After key concepts were introduced, the instructor
demonstrated the skill, and a question and answer period followed. Then each student was given the
opportunity to practice the skill. Lastly, each student was tested and, if unsuccessful, was allowed to be
retested as per the NRS 107 laboratory testing policy (see Appendix B). The timeline for the mastery of
these nursing skills by the students was as follows: Vital Signs – end of Week 4; Medication
Administration – end of Week 7; and Wound Care – end of Week 12.
Blueprinted Test Questions – Students completed the Chapter 4: Legal Aspects of Nursing and Chapter
5: Values, Ethics & Advocacy pre- and post-tests on the online learning management system, My Nursing
Lab (MNL) associated with the required textbook (by Kozier & Erb, 2012), respectively, one week before
and right after the lecture presentations on these topics. In addition, final exam questions related to
legal and ethical aspects of nursing (see Appendix C) were blueprinted to specific course learning
objectives; i.e., to coincide with lecture and laboratory measurable performance objectives (MPOs).
Results
Course Goal #5 – The overall performance of each student on each nursing skill tested was based on
his/her ability to complete each of the skill’s critical elements. Students were rated on each skill
element as follows: met, not met, pass, or fail. The summary of the cumulative performance success
rate for each test-off skill is found in Appendix D. Of note is the fact that 100% of the students tested
eventually passed the required test-offs. However, students did not always complete the test-offs on
their first try or within the time period allocated.
Course Goal # 10 – The overall student scores on Chapter 4 and 5 online pre- and post-tests are
documented in Appendix E. Twenty-one out of 22 students completed the tests.
Fifteen students (71%) scored 76% and above on the Chapter 4 (Legal) pre-test, and 100% scored above
76% on the post-test. A full 81% (17) of the students earned higher scores on their Chapter 4 post-tests
in comparison to their pre-test scores indicating value added by the course.
Eight students (38%) scored 76% and above on the Chapter 5 (Ethics) pre-test, and 43% scored above
76% on the post-test. 52% (11) of the students earned higher scores on their Chapter 5 post-tests in
comparison to their pre-test scores indicating value added by the course.
There were 7 final exam questions blueprinted to course objectives related to the values, ethics and
legal aspects of nursing. The number of students who answered the blueprinted questions correctly is
reported in Appendix F. The questions answered correctly ranged from a low of 55% (Question 29) to a
high of 100% (Question 26). However, based on the results from Question 29 and the item analysis
subsequently performed, it was deemed that the distractors present may have been poorly worded and
ambiguous leading to student underperformance on this question. Therefore, Question 29 will be
excluded from future testing events. In addition, since every student answered Question 26 correctly,
this question will be reviewed to determine if it is too easy/lacks the appropriate level of difficulty. It is
NRS 107 – 2
possible, however, that the small sample size of this study may affect proper item analysis and
interpretation.
Conclusion
Several conclusions can be drawn from the findings of this student learning outcomes assessment data.
First, it is clear that the majority of students is able to pass the basic nursing skills test-offs on the first
attempt and, thus, have achieved NRS 107 Course Goal #5. However, in some cases this was
accomplished by permitting extra time to practice and by extending the deadline for test-offs. Indirect
assessment data collected from NRS 107 course evaluations completed by nursing students cite lack of
open lab hours for practice and lack of student confidence as some of the reasons for needing extra time
to test-off. Therefore, the following are highly recommended: 1) Provide additional open laboratory
hours for practice of required skills (checking vital signs, administering medication, and caring for
wounds); and 2) Modify the timeline of final test-off dates for required skills by adding one additional
week, Fall 2012.
As for student achievement of NRS 107 Course Goal # 10, outcomes assessment data results obtained
from the pre- and post-tests and blueprinted final exam questions indicate that students performed
better on the final exam questions (given in Week 16) as compared to when similar content questions
were first presented in Week 3. Perhaps this may be explained by assuming that over the course of the
semester, students were able to digest the information as well as spend additional time studying and,
therefore, did well on the final exam questions. It is important to note, however, that because average
scores of all assigned pre-and post-tests are used in calculating a fifth exam score, which counts toward
the overall NRS 107 course grade, students may be able to score higher initially if additional resources
were provided to reinforce the content right away. For this reason, it is recommended that students
access the EDGT online tutorial “Ethical and Legal Considerations in Nursing” after the ethical and legal
lecture (Week 3) and then complete the MNL post-test.
NRS 107 – 3
NRS 107 – APPENDIX A – Critical Elements Checklist
Topic
For All Skills
Hand Washing
Critical Elements
Met
Not
Met
1. Standard
Precautions/Hand
Washing
2. Safety / Joint
Commission
Standard for Client
Identification
3. Client / Ensure Client
is Comfortable,
Aware of the
Procedure and
Provided with Privacy
4. Infection Control /
Utilize Appropriate
PPE
5. Gather Necessary
Equipment
6. Dispose of Equipment Appropriately
7. Document Relevant
Data
1. Differentiate the
Need for Soap and
Water Versus Hand
Sanitizer
2. Remove All Jewelry
3. Turn on Water – Use
an Appropriate
Temperature and
Apply Sufficient Soap
4. Wash Hands for a
Minimum of 20
Seconds Using Firm
Rubbing and Circular
Movements to the
Palms, Backs of
Hands, Wrists, and
Between the Fingers
5. Thoroughly Dry
Hands
6. Turn Off the Water.
Use a Dry Paper
Towel if Needed
NRS 107 – Appendix A – 1
Pass/Fail
Date/Signature
Topic
Critical Elements
Met
Not
Met
Vital Signs
Blood Pressure
Respiratory Rate
Apical Pulse
Radial Pulse
1. Choose the
Appropriate Size
Blood Pressure Cuff
for the Client
2. Palpate the Brachial
Artery
3. Position the
Stethoscope
4. Auscultate the
Client’s Blood
Pressure with
Accuracy within
2mmHg
1. Observe Client
Respirations
2. Count Respirations
for 60 Seconds
3. Assess for Depth,
Rhythm and
Character
4. Identify the Correct
Rate
1. Locate the Apical
Pulse (PMI)
2. Place the
Stethoscope over the
Apical Pulse
3. Listen and Count for
60 Seconds
4. Assess Pulse Rate,
Rhythm and Strength
5. Identify the Correct
Rate
1. Select and Correctly
Name the Pulse Point
2. Palpate and Count
the Pulse
3. Assess the Pulse
Rhythm and Volume
4. Identify the Correct
Rate
NRS 107 – Appendix A – 2
Pass/Fail
Date/Signature
Topic
Temperature
Pain
Oxygen Saturation
Critical Elements
Met
Not
Met
1. Select Correct
Equipment
2. Obtain an Accurate
Temperature
1. Assess the Location,
Intensity, Quality,
Onset, Duration,
Precipitating Factors,
and Alleviating
Factors
2. Demonstrate /
Describe the Use of
the 10-point Pain
Scale
3. Demonstrate /
Describe WongBaker FACES Rating
Scale
1. Select Appropriate
Equipment
2. Correctly Apply the
Sensor
3. Describe Alternate
Sites and Rationale
Medication Administration
Safety
1. Demonstrate
/Describe the 10
Rights of Medication
Administration
2. Identify the Client
Using at Least 2
Identifiers
3. Verify Orders/MAR
4. Calculate and
Prepare the Dose
Accurately
5. Identify Appropriate
Assessment Needs as
per Medication
Order &/or Client
Condition
NRS 107 – Appendix A – 3
Pass/Fail
Date/Signature
Topic
Safety (continued)
Oral
Topical
Parenteral/Injection
Critical Elements
Met
Not
Met
6. Select the
Appropriate
Equipment
7. Take MAR to Bedside
8. Check for Medication
Expiration
1. Assess Patient’s
Ability to Take Oral
Medication/Swallow
2. Open Unit Dose
Medication at the
Bedside
1. Inspect Skin for Areas
of Lesions, Rashes,
Erythema &/or
Breakdown
2. Remove and Dispose
of Old Medication
Patch Safely
1. Select the Correct
Medication
2. Select the Correct
Equipment
3. Give the Accurate
Dose
4. Accurately Describe
the Appropriate Site,
Landmarks and
Rationale
5. Cleanse the Site with
Appropriate
Technique
6. Activate Needle
Safety System Prior
to Disposal / Dispose
of Equipment
Appropriately
Wound Management
Sterile Wound Dressing
Change
1. Assess client for
pain/comfort
2. Prepare client for
procedure
NRS 107 – Appendix A – 4
Pass/Fail
Date/Signature
Topic
Critical Elements
Sterile Wound Dressing
Change
3. Remove Soiled
Dressing Using
Appropriate Barrier &
Discard Appropriately
4. Establish a Sterile
Field
5. Does Not
Contaminate the
Field
6. Don Sterile Gloves
Without
Contamination
7. Cleanse the Wound
as Ordered
8. Apply Appropriate
Dressing as Ordered
9. Secure the Dressing
10. Sign and Date
11. Discard Soiled
Equipment in
Appropriate
Container
Met
Not
Met
NRS 107 – Appendix A – 5
Pass/Fail
Date/Signature
NRS 107 – APPENDIX B – Laboratory Testing Policy
1. Students must enter each laboratory session having completed the required readings and study
questions. At the beginning of each session, a brief question and answer period will clarify any
confusing content.
2. Each laboratory session will begin with a demonstration of the skill or skills to be learned.
3. Students are expected to practice the skill during the remainder of the class time and during
additional open laboratory periods.
4. Students must practice the skill BEFORE performing a nursing skill test.
a. Students are responsible for making appointments for testing well before the final deadline!
b. During test-offs, students will not be able to observe the testing of other students.
c. Students are responsible for ensuring that a record of the successful test-off is documented by
the laboratory instructor.
d. In order to successfully complete or “pass” a lab skill, the student must successfully perform ALL
critical elements for the particular lab skill being tested in the time period allotted.
e. If the student does not perform all critical elements for a particular skill, the student will be
allowed to re-test a second time AFTER all other students have been tested.
f. Failure to pass a second time will result in a written warning and counseling by the course
coordinator.
5. If a student fails the skill on the third attempt, the student will fail the laboratory component of the
course and, thus, will fail Nursing I.
6. A student may not care for clients in the clinical area until the following skills have been completed
and return demonstration performed:
a.
b.
c.
d.
CDC’s Standard Precautions
Bed Bath
General Assessment
Vital Signs (test-off will occur in the clinical area during Weeks 3 & 4)
Laboratory test-off deadlines: Students must successfully test off on the following skills by the deadline
stated. Failure to do so will result in laboratory failure and thus failure for the course.
Vital Signs: end of Week 4
Medication Administration: end of Week 7
Wound Care: end of Week 12
<< See critical elements checklist for test-off details. >>
NRS 107 – Appendix B – 1
NRS 107 – APPENDIX C – 7 Legal & Ethical Blueprinted Final Exam Questions
18.
The nurse enters the room and tells the client tht he has to take his medication, including an
injection. The client refuses this medication, but the nurse continues to administer
them. This action is an example of the intentional tort of:
a.
b.
c.
d.
19.
The nurse is collecting information from a client's family. The client is confused and not able
to contribute to the conversation. The spouse states, "This is not his normal behavior." The
nurse documents this as which of the following:
a.
b.
c.
d.
26.
Inference
Subjective Data
Objective Data
Secondary Subjective Data
A nurse forgets to put the call light within the client's reach and then leaves the room. The
client reaches for it and falls out of bed. The nurse could be charged with which of the
following?
a.
b.
c.
d.
29.
Assault
Battery
Invasion of Privacy
Malpractice
Assault
Battery
Negligence
Criminal Intent
An alert and mentally competent client wishes to discontinue treatment for his cancer. Acting
as the client advocate, the nurse makes this statement to the client's physician:
a.
b.
c.
d.
"The client is making his own decision."
"The client would benefit from additional information about treatment options."
"The family must be involved in this decision."
"Let's educate the family about the consequences of this decision."
NRS 107 – Appendix C – 1
34.
The nurse carries out a medication order, incorrectly written by the physician and
subsequently filled by the pharmacist. Who, in this situation, is legally liable for the action?
a.
b.
c.
d.
66.
The nurse makes this entry in a client's medical record: "The client is a drug addict and is
always asking for more medication than what is necessary." In this situation, the nurse may be
charged with which of the following?
a.
b.
c.
d.
95.
Physician
Pharmacist
Hospital
Nurse
Defamation
Slander
Libel
Incompetence
The nurse responds to a client's call light. When entering the room, the nurse sees that the
client is lying on the floor, with the bed linens around the legs. The most correctly written
chart entry is:
a.
b.
c.
d.
Client fell out of bed, but did push the call button for assistance.
Client became tangled in the bed linens, then called for assistance after falling out of bed.
Recorder responded to client's call light, upon entering the room, found client on floor.
Client found on floor, appeared to have fallen out of bed as a result of getting tangled in bed
linens.
NRS 107 – Appendix C – 2
NRS 107 – APPENDIX D – Student Skills Test-off Results
PASS 1ST
ATTEMPT
PASS 2ND
ATTEMPT
PASS 3RD
ATTEMPT
FAILED
VITAL SIGNS
 BP
 Temperature
 Pulse
 Respirations
20
2
0
0
MEDICATION
ADMINISTRATION
 PO
 Subq
 IM
 Topical
17
5
0
0
WOUND CARE
 Surgical Incision
 Wound Healing
by Secondary
Intention
22
0
0
0
SKILL
NRS 107 – Appendix D – 1
NRS 107 – APPENDIX E – Chapters 4 & 5 Pre- & Post-test Results
(N = 21 students)
Chapter 4
Pre-test
Chapter 4
Post-test
Chapter 5
Pre-test
Chapter 5
Post-test
83
79
67
58
96
88
63
79
58
79
83
71
79
88
71
83
83
88
92
79
88
96
76
76
88
96
92
88
80
76
80
76
100
88
96
88
92
84
80
96
92
92
80
70
80
80
80
50
60
60
60
50
90
80
70
80
40
60
70
50
70
60
80
80
90
80
80
70
90
70
70
60
70
70
100
100
70
60
60
70
100
80
70
70
NRS 107 – Appendix E – 1
NRS 107 – APPENDIX F – Blueprinted Legal/Ethical Final Exam Question Results
NRS 107 – Appendix F – 1