Evaluating the Importance of Clinical Judgment in Entry-Level Nursing.

BACKGROUND: This study investigated the extent to which clinical judgment is important in entry-level nursing practice. METHOD: A task analysis linkage study methodology based on a large-scale, comprehensive practice analysis was used for the study. The practice analysis validated more than 200 entry-level nursing tasks, and the linkage study sought to evaluate the importance of clinical judgment overall and for each specific task expectation. RESULTS: The results provide confirmatory evidence of the importance of clinical judgment. In addition, the work provides a comprehensive list of entry-level tasks and their associated clinical judgment importance. CONCLUSION: Clinical judgment is a vital skill at entry into the profession and is expected to grow over time. This study offers insights on the extent to which clinical judgment is a necessary skill and provides direct evidence of its importance for specific entry-level tasks. [J Nurs Educ. 2024;63(3):156-162.].

Integrating Clinical Judgment Into the Entry-Level Nursing: A Confirmatory Factor Analytic Study.

Background and purpose: Clinical judgement (CJ) is a complex variable that utilizes higher level cognitive processing related to clinical reasoning, decision-making, and critical thinking. As CJ is a vital aspect of nursing, the current study evaluated the extent to which the current NCLEX item bank assesses CJ and a critical aspect of measuring new constructs using a dimensionality analysis. Methods: A Confirmatory Factor Analysis was completed to evaluate the factor structure of items written to the National Council of State Boards of Nursing Clinical Judgment Measurement Model (CJMM) that directly measures CJ with respect to extant NCLEX items. Results: Results indicated that scenarios written using the CJMM were found to have a unidimensional structure. Conclusions: The results suggested that the scenarios written with the CJMM could be scaled concurrently with the current NCLEX items.

Location-Matching Adaptive Testing for Polytomous Technology-Enhanced Items.

The article presents adaptive testing strategies for polytomously scored technology-enhanced innovative items. We investigate item selection methods that match examinee's ability levels in location and explore ways to leverage test-taking speeds during item selection. Existing approaches to selecting polytomous items are mostly based on information measures and tend to experience an item pool usage problem. In this study, we introduce location indices for polytomous items and show that location-matched item selection significantly improves the usage problem and achieves more diverse item sampling. We also contemplate matching items' time intensities so that testing times can be regulated across the examinees. Numerical experiment from Monte Carlo simulation suggests that location-matched item selection achieves significantly better and more balanced item pool usage. Leveraging working speed in item selection distinctly reduced the average testing times as well as variation across the examinees. Both the procedures incurred marginal measurement cost (e.g., precision and efficiency) and yet showed significant improvement in the administrative outcomes. The experiment in two test settings also suggested that the procedures can lead to different administrative gains depending on the test design.

Evaluating Different Scoring Methods for Multiple Response Items Providing Partial Credit.

The multiple response structure can underlie several different technology-enhanced item types. With the increased use of computer-based testing, multiple response items are becoming more common. This response type holds the potential for being scored polytomously for partial credit. However, there are several possible methods for computing raw scores. This research will evaluate several approaches found in the literature using an approach that evaluates how the inclusion of scoring related to the selection/nonselection of both relevant and irrelevant information is incorporated extending Wilson's approach. Results indicated all methods have potential, but the plus/minus and true/false methods seemed the most promising for items using the "select all that apply" instruction set. Additionally, these methods showed a large increase in information per time unit over the dichotomous method.

Computerized adaptive testing for testlet-based innovative items.

Increasing use of innovative items in operational assessments has shedded new light on the polytomous testlet models. In this study, we examine performance of several scoring models when polytomous items exhibit random testlet effects. Four models are considered for investigation: the partial credit model (PCM), testlet-as-a-polytomous-item model (TPIM), random-effect testlet model (RTM), and fixed-effect testlet model (FTM). The performance of the models was evaluated in two adaptive testings where testlets have nonzero random effects. The outcomes of the study suggest that, despite the manifest random testlet effects, PCM, FTM, and RTM perform comparably in trait recovery and examinee classification. The overall accuracy of PCM and FTM in trait inference was comparable to that of RTM. TPIM consistently underestimated population variance and led to significant overestimation of measurement precision, showing limited utility for operational use. The results of the study provide practical implications for using the polytomous testlet scoring models.

Does delaying judgments of learning really improve the efficacy of study decisions? Not so much.

A widely held assumption in metamemory is that better, more accurate metamemory monitoring leads to better, more efficacious restudy decisions, reflected in better memory performance--we refer to this causal chain as the restudy selectivity hypothesis. In 3 sets of experiments, we tested this hypothesis by factorially manipulating metamemory monitoring accuracy and self-regulation of study. To manipulate monitoring accuracy, we compared judgments of learning (JOLs) made contemporaneously with a delayed retrieval attempt to JOLs either made at a delay without attempting retrieval or made immediately after study; in previous studies, delayed retrieval-based JOLs have robustly predicted recall with greater relative accuracy than have the other JOL types. To manipulate self-regulation of study, in Experiments 1A-1C and 2A-2C, we compared conditions in which participants' restudy selections were honored with conditions in which they were completely or randomly dishonored; in Experiments 3A-3C, we randomly honored or dishonored half of the restudy selections and half of the nonselections. Results revealed that the benefit of delayed, retrieval-based JOLs for final memory performance was due largely to the selection of more items for restudy rather than to better discriminations between items that would benefit more versus less from restudy. In most cases, gains in recall due to greater self-regulation of study did not increase with better monitoring accuracy; when they did, the effect was extremely small. The surprising conclusion was that restudy decisions were not very much more efficacious under conditions that yield greater monitoring accuracy than under those that do not.

Dynamics of thematic activation in recognition testing.

Two experiments investigated the effects of spreading semantic activation during a recognition test. In Experiment 1, activation spreading during testing from words that were thematic associates of unstudied critical words yielded a linear increase in false alarms to such critical words as the number of tested associates increased, regardless of whether the theme appeared during study or whether any thematic processing occurred during study at all. In Experiment 2, the number of tested associates was held constant, and false alarms to critical words from unstudied themes increased linearly with the strength of association between the critical word and its tested associates, consistent with predictions of spreading-activation theory. For studied themes, however, testing weaker or stronger associates yielded similar rates of such false alarms, contrary to spreading-activation theory. These results suggest that test-induced thematic priming is driven by spreading activation for unstudied themes but by thematic reactivation for studied themes.