1. Enhancing Student Learning and Critical Thinking Skills Via Computer Assisted Methods L. P. Gallagher EdD, RN, FNP D. Hallas PhD, APRN, BC, CPNP

2. Focus of the Learning Assessment Project To enhance critical thinking skills in individual students as measured by performance on in- class examinations and standardized examinations throughout the nursing curriculum

3. At-Risk Students Phase I In phase I, all of the students who were invited to participate were identified as at-risk students. At-risk students had previously failed a nursing course who had performed poorly on in-class examinations cumulative grade point average was borderline.

4. Question Addressed Will students who participate in this computer enhanced assessment project achieve success on in-class and/or standardized examinations?

5. Short Term Goals Phase I Students who were performing below minimal competence in sophomore level nursing courses will successfully pass the sophomore level nursing courses. Students will remain in the nursing program and continue to be successful in upper division nursing courses (Junior and Senior years).

6. Short Term Goal Phase II Assist the RN4 senior level students to pass the comprehensive exit examination The graduates will pass the NCLEX-RN exam on the first attempt

7. Long Term Goals Students will graduate within the expected four-year time frame for completion of the baccalaureate- nursing program. Upon graduation, the students will pass the NCLEX-RN examination on the first attempt consistent with the goals of Lienhard School of Nursing.

8. Background and Significance Student who are unsuccessful on examination questions Invitation to participate in the project Analysis and Application Style questions Changing passing standard on the licensure examination

9. Methodology Invitation to apply after review of in-class performance Ten students registered for phase I of the project Nineteen students registered for phase II of the project

10. Phase I Pre-test critical thinking Factual critical thinking test was designed modeled after standardized critical thinking exams Instruction in test taking skills Practice Post-Test critical thinking

11. Testing Models Used RACE model Nursing Process Maslow’s Hierarchy of Needs

12. The RACE Model R A C E R = Recognize A = Ask C = Critically Analyze E = Eliminate distractors one at a time

13. Nursing Process Assessment Planning Intervention Evaluation

15. Pre-Test and Post-Test Phase I Pre-test Post-Test

16. Sample Pre-test Item and Results Consider the statement, “All sick people should visit a doctor.” A usually healthy 25- year-old call work to repot that he is ill. Therefore, the man

17. Responses A.Should see a doctor B.Should see a doctor if his symptoms do not improve quickly C.Is like most other people his age who becomes ill D.May not get well unless he sees a doctor A.80% B.10% C.0% D.10%

18. Sample Post Test Item and Results Which nursing intervention would take priority when caring for a client recently discharged from the hospital?

19. Responses A.Exploring the need to modify the environment to prevent falls B.Teaching the family how to feed a client who has a decreased gag reflex C.Encouraging the client to ventilate negative feelings about the loss of independence D.Providing the opportunity for the client to make choices concerning the plan of care A.16.6% B.33.3% C.0% D.33.3% Unanswered 16.6%

20. Phase II Senior Level Students On-line computer enhanced instruction 3 week course emphasizing analysis and application style questions

21. Results  Results from the Pre-Test in Critical Thinking:  Ten students took the pre-test and 80% received a score above 70%.

22. Results for Sophomores and Juniors – Phase I Two sophomore level students were successful in passing all sophomore level courses. One junior level student was successful in passing the fall 2003 semester while she was enrolled in this project

23. Results for Seniors Phase I  Six seniors participated in the fall 2003 semester project:  50% of the students successfully completed the comprehensive standardized exit examination administered in the Spring 2004 semester.

24. Results Phase I  Results from the Post-Test in Critical Thinking: 50% of the students took this examination.  No student received a score of 70% or above which was the passing standard.  The scores ranged from 30% to 60%.  Why?

25. Results Phase II 19 of 32 senior level nursing students participated in Phase II. Of the 19 students, 79% (15/19) of the students successfully passed the comprehensive exit examination

26. Results – Actual Use by Students - Phase II Three students used the internet completing from 40.13 to 98.36% attendance Ten students used the internet from 1.54 to 16.84% Six students never uses the internet program during th ethree week period

27. Comparison of internet to exit exam results Frequent Users Moderate Users No participation Two passed Nine of ten students passed Four of the six passed* * These four students were good students

28. Results Phase II  Of the thirteen students who did not participate in this learning assessment project, 69% (9/13) of the students successfully passed the comprehensive examination.

29. Discussion The critical thinking pre-test results administered in phase I showed that 80% of the students were able to think logically and sort factual information. Two senior level students’ who failed the critical thinking pre-test, also failed the comprehensive exit examination administered in the spring 2004 semester.

30. Discussion (cont) The comprehensive exit examination results showed that these two students’ scores continued to improve each time they took the examination. This may indicate that, given time, these students may be able to develop the necessary critical thinking skills to be successful on this the exit examination.

31. Discussion (cont) In phase I, all students were unsuccessful on the critical thinking post test which measured prioritizing patient care needs. The items measured on this examination are representative of high level NCLEX-RN examination questions

32. Discussion (cont) It is believed that the student who participated in the critical thinking post test were not successful because the quality of the questions were at a high level and limited in number.

33. Discussion (cont) 50% of the senior level students were successful on the comprehensive exit examination. The investigators believe that this success is related to the variety in the level of questions on this examination and the total number of 180 questions which the students answer.

34. Discussion The majority of the students who did not participate in phase II of this learning assessment project were high achieving students. Students who participated in phase II were more successful on the exit examination as compared to those students who did not participate. This supports the need for formal preparation in critical thinking skills to achieve testing success.

35. Discussion Higher level students succeed whether or not they participated in the enhanced instruction Moderate level students were successful with some practice Lower level students who did not participate were not able to be successful (these students were considered at-risk from phase I of the study)