WEBVTT 00:00:00.070 --> 00:00:02.630 position:50% align:middle - [Dr. Quinn] Hello, everyone, and welcome. 00:00:02.630 --> 00:00:06.470 position:50% align:middle Thank you so much for taking time to join today's webinar. 00:00:06.470 --> 00:00:10.190 position:50% align:middle On behalf of the leadership and staff at the Center to Champion Nursing in America, 00:00:10.190 --> 00:00:15.220 position:50% align:middle I thank you all for taking time to join us for this important discussion. 00:00:15.220 --> 00:00:20.210 position:50% align:middle The Future of Nursing Campaign for Action and the National Council of State Boards of Nursing 00:00:20.210 --> 00:00:27.470 position:50% align:middle are happy to bring today's webinar focused on Next-gen National Council Licensure Examination, 00:00:27.470 --> 00:00:29.560 position:50% align:middle otherwise known as NCLEX. 00:00:29.560 --> 00:00:33.708 position:50% align:middle For the past several years, the campaign has worked with minority-serving schools of nursing 00:00:33.708 --> 00:00:39.767 position:50% align:middle from historically black colleges and universities, Hispanic, and American Indian Alaska Native 00:00:39.767 --> 00:00:44.800 position:50% align:middle serving institutions who enhance and/or establish mentoring programs that 00:00:44.800 --> 00:00:49.660 position:50% align:middle help students remain in school, graduate, and pass their NCLEX. 00:00:49.660 --> 00:00:55.180 position:50% align:middle With the upcoming release of next-gen NCLEX, many of these schools have expressed the need to learn 00:00:55.180 --> 00:00:59.380 position:50% align:middle more about the exam to adequately prepare their students. 00:00:59.380 --> 00:01:04.349 position:50% align:middle We are delighted, really just delighted to co-sponsor today's webinar with 00:01:04.349 --> 00:01:06.794 position:50% align:middle the National Council of State Boards of Nursing, 00:01:06.794 --> 00:01:13.180 position:50% align:middle who so graciously agreed to offer this webinar to support our efforts and your efforts 00:01:13.180 --> 00:01:18.140 position:50% align:middle with minority-serving schools, and our overall goal to increase diversity in nursing 00:01:18.140 --> 00:01:20.510 position:50% align:middle to help achieve health equity. 00:01:20.510 --> 00:01:25.100 position:50% align:middle Before we go further, I want to mention we are recording today's webinar. 00:01:25.100 --> 00:01:30.570 position:50% align:middle If you miss a section or would like to pass it on to a colleague, which we very much encourage you to do, 00:01:30.570 --> 00:01:41.875 position:50% align:middle you can find the recording by going to www.campaignforaction.org/webinars. 00:01:41.875 --> 00:01:47.280 position:50% align:middle And now I have the honor of introducing today's presenter and expert on the 00:01:47.280 --> 00:01:53.940 position:50% align:middle next-gen NCLEX, Mr. Jason Schwartz, who is the director of Test Development and Examination 00:01:53.940 --> 00:01:56.920 position:50% align:middle at the National Council of State Boards of Nursing. 00:01:56.920 --> 00:02:00.000 position:50% align:middle So thank you for joining us today Mr. Schwartz. 00:02:00.000 --> 00:02:00.870 position:50% align:middle Please, take it away. 00:02:00.870 --> 00:02:03.500 position:50% align:middle - [Jason] Well, thank you very much, Win. 00:02:03.500 --> 00:02:04.750 position:50% align:middle Thank you, everybody. 00:02:04.750 --> 00:02:10.770 position:50% align:middle It's really an honor for me and a pleasure to be part of such important work and with such distinguished 00:02:10.770 --> 00:02:12.110 position:50% align:middle guests and attendees. 00:02:12.110 --> 00:02:18.010 position:50% align:middle So we will jump in because I brought a lot of material if that's okay. 00:02:18.010 --> 00:02:24.328 position:50% align:middle I am going to talk fast through the things that are nice to know and go slower 00:02:24.328 --> 00:02:26.860 position:50% align:middle for the things that you really need to know. 00:02:26.860 --> 00:02:34.540 position:50% align:middle So I call this Countdown to Launch for the Next Generation NCLEX because the next generation NCLEX is 00:02:34.540 --> 00:02:37.520 position:50% align:middle now just barely over a year away. 00:02:37.520 --> 00:02:39.263 position:50% align:middle April 1st is our launch date. 00:02:39.263 --> 00:02:42.360 position:50% align:middle April 1st of 2023 I should clarify. 00:02:42.360 --> 00:02:44.898 position:50% align:middle I hope nobody took that as 2022. 00:02:44.898 --> 00:02:46.390 position:50% align:middle At any rate, here we go. 00:02:46.390 --> 00:02:47.520 position:50% align:middle Countdown to launch. 00:02:47.520 --> 00:02:49.030 position:50% align:middle We start with some legalese. 00:02:49.030 --> 00:02:52.670 position:50% align:middle If you see something, share something that's why we're here, 00:02:52.670 --> 00:02:53.620 position:50% align:middle that's why I'm here. 00:02:53.620 --> 00:02:58.650 position:50% align:middle The whole point is if you see something that would be beneficial to your colleagues, or even your students, 00:02:58.650 --> 00:02:59.760 position:50% align:middle please do share it. 00:02:59.760 --> 00:03:02.840 position:50% align:middle You'll have copies of the slides and all of that I promise. 00:03:02.840 --> 00:03:08.231 position:50% align:middle If you see something that you'd put to commercial use to sell, we have an email address 00:03:08.231 --> 00:03:11.656 position:50% align:middle at the bottom of this slide to just check with us first, that's all we ask. 00:03:11.820 --> 00:03:15.230 position:50% align:middle So with that, what am I covering today? 00:03:15.230 --> 00:03:20.570 position:50% align:middle We'll go quick on where we are with the next generation NCLEX and essentially, 00:03:20.570 --> 00:03:23.570 position:50% align:middle why we're making changes to the NCLEX. 00:03:23.570 --> 00:03:27.763 position:50% align:middle From there, we'll spend, I'm going to say ample time for the bulk of the presentation 00:03:27.763 --> 00:03:34.100 position:50% align:middle looking at the kinds of new test questions that your graduates will see on the exam. 00:03:34.100 --> 00:03:38.210 position:50% align:middle And good news or bad news depending, what you came to do today, 00:03:38.210 --> 00:03:41.010 position:50% align:middle we are turning that into a hands-on activity as well. 00:03:41.010 --> 00:03:45.010 position:50% align:middle So I'm going to be showing you the new content, and then you are going to be working with me 00:03:45.010 --> 00:03:47.390 position:50% align:middle to develop new content. 00:03:47.390 --> 00:03:48.500 position:50% align:middle What else? 00:03:48.500 --> 00:03:50.730 position:50% align:middle We have what we call the test design. 00:03:50.730 --> 00:03:53.030 position:50% align:middle I'll explain what that means later. 00:03:53.030 --> 00:03:58.220 position:50% align:middle But it's stuff like how many items are on the test, did the test get longer, did it stay the same size, 00:03:58.220 --> 00:04:00.389 position:50% align:middle these sorts of things, scoring. 00:04:00.389 --> 00:04:07.010 position:50% align:middle And again, I've brought some hands-on activities for all of you to really get involved and 00:04:07.010 --> 00:04:11.600 position:50% align:middle demystify the scoring approaches that we'll be using on the exam. 00:04:11.600 --> 00:04:17.020 position:50% align:middle Finally, I'll point you to the resources that we have on our website, which can be very helpful. 00:04:17.020 --> 00:04:21.940 position:50% align:middle And I've tried to allow some time for questions at the end as well. 00:04:21.940 --> 00:04:22.850 position:50% align:middle Let's jump in. 00:04:22.850 --> 00:04:24.410 position:50% align:middle We've got a lot to cover. 00:04:24.410 --> 00:04:25.810 position:50% align:middle First, the timeline. 00:04:25.810 --> 00:04:31.890 position:50% align:middle So I've been doing presentations like this for I think four years now and this slide is in every single deck. 00:04:31.890 --> 00:04:34.640 position:50% align:middle The only difference is where we are. 00:04:34.640 --> 00:04:40.370 position:50% align:middle We used to be on the second or third box well, gosh, now we're on the sixth and seventh box and quickly 00:04:40.370 --> 00:04:42.150 position:50% align:middle approaching the eighth box. 00:04:42.150 --> 00:04:45.970 position:50% align:middle I won't go into all the boxes here unless I get stuff in the Q&A. 00:04:45.970 --> 00:04:50.920 position:50% align:middle I'll just indicate that many people first heard that the exams were changing oh, 00:04:50.920 --> 00:04:57.980 position:50% align:middle around 2018, 2019 maybe 2017 if they were really, really looking for this kind of information. 00:04:57.980 --> 00:05:02.086 position:50% align:middle But we began this work in 2012, literally 10 years ago. 00:05:02.086 --> 00:05:05.218 position:50% align:middle We've been working on this for 10 years. 00:05:05.218 --> 00:05:10.420 position:50% align:middle Other key data, of course, is the launch, April 2023. 00:05:10.420 --> 00:05:14.770 position:50% align:middle And this is the first audience to know that it's not just April, but April 1st, 00:05:14.770 --> 00:05:17.930 position:50% align:middle we made that decision I think just in the past couple of days. 00:05:17.930 --> 00:05:21.470 position:50% align:middle So, foundations, where did this exam come from? 00:05:21.470 --> 00:05:23.160 position:50% align:middle Why are we making these changes? 00:05:23.160 --> 00:05:26.950 position:50% align:middle Well, like a comic book character, there's an origin story. 00:05:26.950 --> 00:05:32.910 position:50% align:middle So we have something, it's a meeting essentially, called the NCLEX Examination Committee Meeting. 00:05:32.910 --> 00:05:38.960 position:50% align:middle And these are regulators from different states who have governance or oversight over the NCLEX. 00:05:38.960 --> 00:05:46.660 position:50% align:middle And a very consequential question that was asked in 2012 was, is the NCLEX measuring the right things? 00:05:46.660 --> 00:05:47.840 position:50% align:middle Sounds simple? 00:05:47.840 --> 00:05:55.190 position:50% align:middle Well, we conduct a practice analysis, a scientific study every three years on exactly what 00:05:55.190 --> 00:06:00.190 position:50% align:middle entry-level nurses, RN level and PN level, are doing at the job, right? 00:06:00.190 --> 00:06:07.070 position:50% align:middle We collect data on frequency, data on criticality, and that's how we figure out what to put on the test. 00:06:07.070 --> 00:06:08.850 position:50% align:middle But there's a catch, right? 00:06:08.850 --> 00:06:10.850 position:50% align:middle There's always a catch, isn't there? 00:06:10.850 --> 00:06:16.240 position:50% align:middle There's a catch which is that sometimes there are things that you care about that you'd like to measure, 00:06:16.240 --> 00:06:17.740 position:50% align:middle but you cannot measure. 00:06:17.740 --> 00:06:22.590 position:50% align:middle I'll give a simple example if it's okay to take y'all back to English class in junior high or high school. 00:06:22.590 --> 00:06:29.180 position:50% align:middle You probably had a teacher who cared very much if you could write an essay, a short story, a poem, etc. 00:06:29.180 --> 00:06:33.320 position:50% align:middle However, at the end of the year, if that teacher only had a multiple-choice test, 00:06:33.320 --> 00:06:36.280 position:50% align:middle you would not be tested on if you could write an essay or a poem. 00:06:36.280 --> 00:06:41.670 position:50% align:middle Doesn't mean the teacher didn't care, it meant the teacher was limited by the testing instrument. 00:06:41.670 --> 00:06:43.030 position:50% align:middle Well, that was us. 00:06:43.030 --> 00:06:48.400 position:50% align:middle But what we decided to do...and spoiler alert, I am leading into clinical judgment right now. 00:06:48.400 --> 00:06:53.910 position:50% align:middle What we decided to do is pretend there were no barriers, pretend that we could test anything we 00:06:53.910 --> 00:06:55.170 position:50% align:middle needed to test. 00:06:55.170 --> 00:07:00.060 position:50% align:middle And if the technology and test instrument and item types didn't support that, well, 00:07:00.060 --> 00:07:01.930 position:50% align:middle maybe we could change those things. 00:07:01.930 --> 00:07:04.180 position:50% align:middle So we began two things. 00:07:04.180 --> 00:07:08.245 position:50% align:middle And I'm collapsing about five-ish years of research here into 00:07:08.245 --> 00:07:11.245 position:50% align:middle about 5 to 10 minutes in the interest of time. 00:07:11.245 --> 00:07:14.210 position:50% align:middle But at any rate, we did two things, a literature review, 00:07:14.210 --> 00:07:19.910 position:50% align:middle and a special practice analysis that we called our Strategic Practice Analysis. 00:07:19.910 --> 00:07:22.290 position:50% align:middle Let's start with the lit review. 00:07:22.290 --> 00:07:27.410 position:50% align:middle And this is information as educators that will not be at all a surprise to you. 00:07:27.410 --> 00:07:34.440 position:50% align:middle Well, even back in 2012, education had already changed, right, to incorporate more clinical judgment, 00:07:34.440 --> 00:07:37.622 position:50% align:middle decision making, critical thinking, etc. 00:07:37.622 --> 00:07:39.045 position:50% align:middle Education was already there. 00:07:39.045 --> 00:07:44.040 position:50% align:middle Our NCLEX wasn't quite where you were, I think, but education was definitely there. 00:07:44.040 --> 00:07:46.830 position:50% align:middle But what was going on in practice? 00:07:46.830 --> 00:07:54.340 position:50% align:middle Well, data showed us 50% of new nurses were involved in errors with just about two-thirds connected to 00:07:54.340 --> 00:07:57.467 position:50% align:middle clinical decision making and judgment. 00:07:57.467 --> 00:08:05.410 position:50% align:middle And only 20% of employers were satisfied with the clinical decision-making skills of their new hires. 00:08:05.410 --> 00:08:07.260 position:50% align:middle What does this all add up to? 00:08:07.260 --> 00:08:11.880 position:50% align:middle Well, it means clinical judgment is critical for patient safety and public protection, 00:08:11.880 --> 00:08:16.090 position:50% align:middle but there's a key phrase, even at the entry level. 00:08:16.090 --> 00:08:23.347 position:50% align:middle Something to note, the NCLEX is not an exam of advanced nursing for very experienced master nurses 00:08:23.347 --> 00:08:24.410 position:50% align:middle 10 years in practice. 00:08:24.410 --> 00:08:28.120 position:50% align:middle No, no, no, it's a gateway to begin a nursing career. 00:08:28.120 --> 00:08:33.350 position:50% align:middle Therefore, if clinical judgment were important for nursing but not yet at the entry-level, 00:08:33.350 --> 00:08:34.478 position:50% align:middle it wouldn't have made our cut. 00:08:34.478 --> 00:08:39.250 position:50% align:middle But even at the entry-level critical to patient safety and public protection. 00:08:39.250 --> 00:08:41.550 position:50% align:middle You see the numbers right here. 00:08:41.550 --> 00:08:47.610 position:50% align:middle And so the question then is, can we test it and how? 00:08:47.610 --> 00:08:53.200 position:50% align:middle Well, before I get to that, I will show something that was a companion piece to our 00:08:53.200 --> 00:09:00.070 position:50% align:middle strategic practice analysis but it seemed for a lot of audiences, more interesting to look at than to read a 00:09:00.070 --> 00:09:03.090 position:50% align:middle very dense research report, although you can do that too. 00:09:03.090 --> 00:09:04.640 position:50% align:middle Let me show the picture. 00:09:04.640 --> 00:09:07.190 position:50% align:middle It might look like a spider web or something. 00:09:07.190 --> 00:09:14.490 position:50% align:middle But I'm going to pretend it's a clock and let's say from 12:00 to 7:00, you see 63 nursing skills. 00:09:14.490 --> 00:09:19.440 position:50% align:middle You can think of a nursing skill like therapeutic communication if you like. 00:09:19.440 --> 00:09:21.980 position:50% align:middle For 7:00...oops too soon. 00:09:21.980 --> 00:09:26.930 position:50% align:middle 7:00 to midnight, you see 41 nursing tasks. 00:09:26.930 --> 00:09:31.710 position:50% align:middle And so I'm not a nurse, my own background is mathematics and testing 00:09:31.710 --> 00:09:34.077 position:50% align:middle so my examples aren't always solid gold. 00:09:34.077 --> 00:09:40.490 position:50% align:middle But we'll say the nurse doing something related to an IV, you know, perhaps would be one of these tasks 00:09:40.490 --> 00:09:41.360 position:50% align:middle that was observed. 00:09:41.360 --> 00:09:46.260 position:50% align:middle So during the strategic practice analysis, what was of particular interest was the connection 00:09:46.260 --> 00:09:47.940 position:50% align:middle between the skills and the tasks. 00:09:47.940 --> 00:09:51.420 position:50% align:middle For the tasks observed, what skills were needed? 00:09:51.420 --> 00:09:56.400 position:50% align:middle Well, in kind of a typical picture, a particular nursing skill might have attached itself 00:09:56.400 --> 00:09:59.811 position:50% align:middle to 5 tasks, 5 to 10 was a pretty typical number. 00:09:59.811 --> 00:10:01.669 position:50% align:middle I'll just walk you through a few. 00:10:01.669 --> 00:10:02.891 position:50% align:middle This one is a little more like 10. 00:10:02.891 --> 00:10:05.180 position:50% align:middle This one is back to around 5. 00:10:05.180 --> 00:10:07.610 position:50% align:middle This one's back to around 5. 00:10:07.610 --> 00:10:09.400 position:50% align:middle This one's more like 10, right? 00:10:09.467 --> 00:10:10.546 position:50% align:middle You get the idea. 00:10:10.546 --> 00:10:13.630 position:50% align:middle Well, sometimes they're a little funny this one only got one. 00:10:13.630 --> 00:10:19.015 position:50% align:middle But skill 33, clinical judgment, my gosh, 34 out of 41. 00:10:19.015 --> 00:10:25.830 position:50% align:middle In other words, clinical judgment was an important skill for just about everything that nurses were doing. 00:10:25.830 --> 00:10:31.220 position:50% align:middle So that was the highlight of the strategic practice analysis. 00:10:31.220 --> 00:10:33.400 position:50% align:middle Question then, how do we measure? 00:10:33.400 --> 00:10:36.760 position:50% align:middle But first, let's sum up where we are so far. 00:10:36.760 --> 00:10:41.880 position:50% align:middle Clinical judgment, important, necessary, even at the entry level. 00:10:41.880 --> 00:10:49.450 position:50% align:middle We know that clinical judgment can and should improve with experience but you can't start at zero, right? 00:10:49.450 --> 00:10:54.180 position:50% align:middle If you start at zero, there are implications to patient safety. 00:10:54.180 --> 00:10:58.280 position:50% align:middle Number two, well, today's NCLEX, does it address clinical judgment? 00:10:58.280 --> 00:10:59.025 position:50% align:middle Yeah, a little. 00:10:59.025 --> 00:11:02.209 position:50% align:middle We have some items related to prioritization, 00:11:02.209 --> 00:11:05.403 position:50% align:middle we have some if you were to go into the Testing Center, you know. 00:11:05.403 --> 00:11:08.170 position:50% align:middle We don't really let you in as an observer but pretend. 00:11:08.170 --> 00:11:11.540 position:50% align:middle If you were to go in there and you watched an entire test you'd see some where you'd say, oh, 00:11:11.540 --> 00:11:13.040 position:50% align:middle there's some clinical judgment there. 00:11:13.040 --> 00:11:16.790 position:50% align:middle But the point is, it's indirect, it's limited, it's not comprehensive. 00:11:16.790 --> 00:11:21.480 position:50% align:middle The item types we use on the test today, don't get us far enough. 00:11:21.480 --> 00:11:30.910 position:50% align:middle So if we want a more direct evidence-based measure of clinical judgment, we need a lot more research and some 00:11:30.910 --> 00:11:32.160 position:50% align:middle new item types. 00:11:32.160 --> 00:11:34.041 position:50% align:middle I'm going to highlight a phrase. 00:11:34.041 --> 00:11:35.999 position:50% align:middle I like to highlight some key phrases here. 00:11:35.999 --> 00:11:37.980 position:50% align:middle What is the NGN? 00:11:37.980 --> 00:11:39.510 position:50% align:middle What are we trying to do? 00:11:39.510 --> 00:11:48.170 position:50% align:middle Well, all the changes I'm going to describe for you are all about adding direct evidence-based measures 00:11:48.170 --> 00:11:50.140 position:50% align:middle of clinical judgment onto the exam. 00:11:50.140 --> 00:11:56.920 position:50% align:middle This is something critical to patient safety and public protection and we now can test it. 00:11:56.920 --> 00:11:59.240 position:50% align:middle So we need to test it. 00:11:59.240 --> 00:12:02.450 position:50% align:middle So, we talked about how do we measure it? 00:12:02.450 --> 00:12:05.399 position:50% align:middle Well, I'll tell you, but let me give a shout-out. 00:12:05.399 --> 00:12:10.440 position:50% align:middle In the upper right-hand corner, you see an NGN newsletter thumbnail. 00:12:10.440 --> 00:12:15.060 position:50% align:middle And every topic I cover with you today, there is an NGN newsletter that goes 00:12:15.060 --> 00:12:17.130 position:50% align:middle into even more detail. 00:12:17.130 --> 00:12:22.610 position:50% align:middle So if I go too fast, if I'm too confusing, if my examples aren't very good, 00:12:22.610 --> 00:12:28.490 position:50% align:middle you'll see the reference to the newsletter that does, I'll say, as good a job as me. 00:12:28.490 --> 00:12:30.443 position:50% align:middle I don't like to say a better job, right? 00:12:31.719 --> 00:12:34.330 position:50% align:middle I'm going to deliver too. 00:12:34.330 --> 00:12:38.910 position:50% align:middle But the point is, you can supplement everything you get from me with these newsletters. 00:12:38.910 --> 00:12:44.240 position:50% align:middle So jumping right in, you see here our Clinical Judgment Measurement model. 00:12:44.240 --> 00:12:47.030 position:50% align:middle We needed a framework for measuring clinical judgment. 00:12:47.030 --> 00:12:51.420 position:50% align:middle When you're doing something like a test, clinical judgment is sort of big, amorphous, 00:12:51.420 --> 00:12:53.560 position:50% align:middle blurry, difficult, complex. 00:12:53.560 --> 00:12:56.810 position:50% align:middle We needed to break it down into smaller pieces that we can test. 00:12:56.810 --> 00:13:03.170 position:50% align:middle In particular, if you're interested in the test items like I am, and I bet all of you are, 00:13:03.170 --> 00:13:06.820 position:50% align:middle it was this layer three where the magic really happens. 00:13:06.820 --> 00:13:09.700 position:50% align:middle I would encourage you to read the newsletter on the entire model. 00:13:09.700 --> 00:13:12.490 position:50% align:middle But this layer three is where the items are written. 00:13:12.490 --> 00:13:19.190 position:50% align:middle I'm going to blow it up a little bit because these six boxes Recognize Cues, Analyze Cues, 00:13:19.190 --> 00:13:23.120 position:50% align:middle Prioritize Hypotheses, etc., these are going to come up again and again, 00:13:23.120 --> 00:13:24.230 position:50% align:middle in my presentation. 00:13:24.230 --> 00:13:31.640 position:50% align:middle Today, this is really where I'm putting my focus is showing you the new test content and connecting it 00:13:31.640 --> 00:13:36.310 position:50% align:middle to these six boxes so that you understand what do we mean by these six things, right? 00:13:36.310 --> 00:13:40.950 position:50% align:middle And what might other items look like, even ones that I'm not showing you today? 00:13:40.950 --> 00:13:44.510 position:50% align:middle So we're going to jump into that content. 00:13:44.510 --> 00:13:50.240 position:50% align:middle Before we do that, I just want to sum up some things about the Clinical Judgment Measurement Model, 00:13:50.300 --> 00:13:53.470 position:50% align:middle always a mouthful so sometimes we say NCJMM. 00:13:53.470 --> 00:13:55.580 position:50% align:middle But that's also a mouthful, isn't it? 00:13:55.580 --> 00:13:56.620 position:50% align:middle At any rate. 00:13:56.620 --> 00:14:01.840 position:50% align:middle So it is designed to test clinical judgment and decision making in a large-scale, high-stakes setting. 00:14:01.840 --> 00:14:04.600 position:50% align:middle I bolded those because that's us, right, that's the NCLEX. 00:14:04.600 --> 00:14:09.980 position:50% align:middle Over 300,000 candidates a year take this test at testing centers, at computers, right? 00:14:09.980 --> 00:14:13.250 position:50% align:middle Well, that's terrific but it also puts limitations on us. 00:14:13.250 --> 00:14:16.360 position:50% align:middle If you're educators, you might talk one on one with a student, 00:14:16.360 --> 00:14:20.720 position:50% align:middle you might talk to a small group, or you might talk to the whole class and ask certain 00:14:20.720 --> 00:14:23.950 position:50% align:middle questions and almost have discussion and get a sense of... 00:14:23.950 --> 00:14:27.660 position:50% align:middle - [Woman 1] It's just more like shampoo and conditioner. 00:14:27.660 --> 00:14:31.730 position:50% align:middle - [Woman 2] No, no [inaudible]. 00:14:31.730 --> 00:14:35.900 position:50% align:middle - If possible, let me ask for mute for the attendees. 00:14:35.900 --> 00:14:36.660 position:50% align:middle Thank you. 00:14:36.660 --> 00:14:44.320 position:50% align:middle So point is you have more ways than I do to get a sense of clinical judgment in your students. 00:14:44.320 --> 00:14:49.360 position:50% align:middle But in the large-scale, high-stakes setting, we needed a valid and reliable way to do it that really 00:14:49.360 --> 00:14:51.670 position:50% align:middle just had a person at a computer. 00:14:51.670 --> 00:14:55.180 position:50% align:middle So large-scale high-stakes that's what we were doing. 00:14:55.180 --> 00:15:00.000 position:50% align:middle I mentioned it supports the item development and especially that layer three. 00:15:00.000 --> 00:15:03.640 position:50% align:middle But also, I want to say something that we did not do. 00:15:03.640 --> 00:15:08.230 position:50% align:middle Because early on, I think as we started to put out information about the changes coming to the exam, 00:15:08.230 --> 00:15:12.690 position:50% align:middle until we had all the information to share, I think some folks kind of connected the dots, 00:15:12.690 --> 00:15:13.820 position:50% align:middle and that made sense to me, 00:15:13.820 --> 00:15:18.758 position:50% align:middle but wondered if we were somehow at war with the nursing process 00:15:18.758 --> 00:15:21.690 position:50% align:middle or various models of pedagogy and things like that. 00:15:21.690 --> 00:15:24.500 position:50% align:middle And so I want to emphasize, definitely not what we're doing or what we were trying to do, 00:15:24.500 --> 00:15:33.538 position:50% align:middle I would use the metaphor of a highway that had two lanes with successful scholarship and theory 00:15:33.538 --> 00:15:36.670 position:50% align:middle in terms of the science of nursing or the practice of nursing, 00:15:36.670 --> 00:15:39.680 position:50% align:middle and the teaching of nursing, maybe being a second lane. 00:15:39.680 --> 00:15:45.800 position:50% align:middle We weren't trying to cut in, merge tell anybody, they were going the wrong way, or going too slow. 00:15:45.800 --> 00:15:48.363 position:50% align:middle Rather, we were carving out a third lane. 00:15:48.363 --> 00:15:53.380 position:50% align:middle It had no cars in it yet, which was all about large-scale, high-stakes testing of clinical judgment. 00:15:53.380 --> 00:15:54.750 position:50% align:middle That was us. 00:15:54.750 --> 00:15:58.100 position:50% align:middle So let's take a look at the content. 00:15:58.100 --> 00:16:04.870 position:50% align:middle There are two different ways that we'll be measuring clinical judgment on the next generation NCLEX. 00:16:04.870 --> 00:16:08.306 position:50% align:middle The number one way and the biggest change coming to the exam... 00:16:08.306 --> 00:16:14.992 position:50% align:middle if the attention span is going to be overwhelmed after just one part of my presentation, 00:16:14.992 --> 00:16:20.890 position:50% align:middle save it for this, case studies, this is the biggest thing to know well, the case study. 00:16:20.890 --> 00:16:26.830 position:50% align:middle But we also have a second way that we'll be measuring clinical judgment rather than a case study, 00:16:26.830 --> 00:16:30.790 position:50% align:middle which is a set of six items that are all connected together. 00:16:30.790 --> 00:16:37.000 position:50% align:middle We also have items that can just be one at a time, a single item that gives us a little bit more 00:16:37.000 --> 00:16:38.640 position:50% align:middle clinical judgment measurement. 00:16:38.640 --> 00:16:40.325 position:50% align:middle I will show you each of those. 00:16:40.325 --> 00:16:43.660 position:50% align:middle We call one of them a Bowtie item and one of them a Trend item. 00:16:43.660 --> 00:16:46.600 position:50% align:middle So with that, let's jump into the case study. 00:16:46.600 --> 00:16:51.510 position:50% align:middle We have our 2020 newsletter, which focuses heavily on this. 00:16:51.510 --> 00:16:54.900 position:50% align:middle And I would encourage it, if there's one newsletter to read, 00:16:54.900 --> 00:16:58.340 position:50% align:middle this would be the one, although I encourage all of them. 00:16:58.340 --> 00:17:05.830 position:50% align:middle So sample case study, this is literally what the screen would look like for your students when they graduate. 00:17:05.830 --> 00:17:08.930 position:50% align:middle Let's take a look at the anatomy of the screen real quick. 00:17:08.930 --> 00:17:12.810 position:50% align:middle Over where I put the number one case study, screen one of six, what does that do? 00:17:12.810 --> 00:17:18.180 position:50% align:middle It is alerting candidates that hey, this is a case study now, and it's kind of a "you are here." 00:17:18.180 --> 00:17:23.000 position:50% align:middle Because you can imagine as they progress through the case study, eventually they'll see things like screen 00:17:23.000 --> 00:17:26.640 position:50% align:middle five of six, right so they'll always know where they are. 00:17:26.640 --> 00:17:28.970 position:50% align:middle On the left-hand side, we've got a lot of stuff. 00:17:28.970 --> 00:17:32.633 position:50% align:middle But let's start where I put the number two, it's just a one-sentence lead in. 00:17:32.633 --> 00:17:34.130 position:50% align:middle It kind of sets the table, right? 00:17:34.130 --> 00:17:38.569 position:50% align:middle Maybe it says the setting or gives a very brief description of the client. 00:17:39.532 --> 00:17:42.907 position:50% align:middle Okay, 3, 4, 5, 6 go together a little bit. 00:17:42.907 --> 00:17:49.668 position:50% align:middle I bet most of you, if not all, are familiar with what we call the exhibit item type on the NCLEX today. 00:17:49.668 --> 00:17:52.520 position:50% align:middle Well, this is kind of a carryover from that. 00:17:52.520 --> 00:18:00.080 position:50% align:middle Our case studies use a tabbed format to present information to the test taker. 00:18:00.080 --> 00:18:01.660 position:50% align:middle So here we go. 00:18:01.660 --> 00:18:03.360 position:50% align:middle Is it always four tabs? 00:18:03.360 --> 00:18:08.300 position:50% align:middle No, in fact, you're going to see one, I'm going to show it to you in the one we do together 00:18:08.300 --> 00:18:10.860 position:50% align:middle that starts with only one tab, right? 00:18:10.860 --> 00:18:14.250 position:50% align:middle Well, if it starts with four tabs, is it four tabs the whole time? 00:18:14.250 --> 00:18:15.680 position:50% align:middle Not necessarily. 00:18:15.680 --> 00:18:19.690 position:50% align:middle A fifth tab could be added partway through the case study. 00:18:19.690 --> 00:18:22.530 position:50% align:middle So there's nothing sacred about the number of tabs. 00:18:22.530 --> 00:18:28.260 position:50% align:middle The point is we use a tabbed format to provide a lot of information about the client. 00:18:28.260 --> 00:18:34.590 position:50% align:middle So let's go over to the other side of the screen and that's where we put the question or in my business, 00:18:34.590 --> 00:18:36.930 position:50% align:middle we say the item. 00:18:36.930 --> 00:18:45.480 position:50% align:middle With that, I want to emphasize, your graduates will always have access to the entire screen, 00:18:45.480 --> 00:18:50.470 position:50% align:middle they will have access to all the tabs no matter what item they're on. 00:18:50.470 --> 00:18:55.350 position:50% align:middle For the benefit of our eyes, especially mine, needing to read the small print, 00:18:55.350 --> 00:19:00.050 position:50% align:middle I am going to be focusing on half the screen at a time. 00:19:00.050 --> 00:19:03.540 position:50% align:middle Trust me, with my vision, you wouldn't want it any other way. 00:19:03.540 --> 00:19:08.110 position:50% align:middle So the other thing I'm going to do because I know some of you joined on your phone, 00:19:08.110 --> 00:19:12.560 position:50% align:middle and some of you may even be driving, I sure don't want you to read this while you drive. 00:19:12.560 --> 00:19:15.600 position:50% align:middle I am going to read all of this to you. 00:19:15.600 --> 00:19:18.890 position:50% align:middle And I may mispronounce a few specialty terms, but let's go. 00:19:18.890 --> 00:19:25.540 position:50% align:middle The nurse is caring for a 17-year-old male client who reports a recent injury to the left thoracic cage. 00:19:25.540 --> 00:19:27.220 position:50% align:middle History and physical tab. 00:19:27.220 --> 00:19:31.479 position:50% align:middle Client reports injuring his left ribs after being struck by mechanically pitched baseball 00:19:31.479 --> 00:19:32.910 position:50% align:middle in a batting cage last week. 00:19:32.910 --> 00:19:35.630 position:50% align:middle He has significant bruising, feels lightheaded. 00:19:35.630 --> 00:19:38.190 position:50% align:middle Also reports intermittent pain in the left shoulder. 00:19:38.190 --> 00:19:43.071 position:50% align:middle Denies shortness of breath, has some discomfort in the lower-left, pardon me, the left lower chest 00:19:43.071 --> 00:19:44.670 position:50% align:middle when taking a deep breath. 00:19:44.670 --> 00:19:48.140 position:50% align:middle Reports feeling abdominal fullness, occasionally nauseous. 00:19:48.140 --> 00:19:50.460 position:50% align:middle No significant past medical history. 00:19:50.460 --> 00:19:55.580 position:50% align:middle Surgical history includes arthroscopic repair to the left shoulder for a torn rotator cuff last year. 00:19:55.580 --> 00:19:59.600 position:50% align:middle He has not felt well enough to attend baseball practice since the injury. 00:19:59.600 --> 00:20:01.530 position:50% align:middle Well, that was a lot of information. 00:20:01.530 --> 00:20:03.940 position:50% align:middle But guess what, there's more. 00:20:03.940 --> 00:20:05.300 position:50% align:middle Nurses notes. 00:20:05.300 --> 00:20:06.100 position:50% align:middle Let's go. 00:20:06.100 --> 00:20:08.710 position:50% align:middle Patient appears pale, slightly diaphoretic. 00:20:08.710 --> 00:20:14.260 position:50% align:middle Large amount of bruising noted along the left torso and over the LUQ of the abdomen. 00:20:14.260 --> 00:20:15.450 position:50% align:middle Patient is guarded. 00:20:15.450 --> 00:20:19.450 position:50% align:middle There's tenderness upon palpation, dullness to percussion over the abdomen. 00:20:19.450 --> 00:20:23.240 position:50% align:middle Slightly diminished breath sounds on the left, productive cough noted. 00:20:23.240 --> 00:20:26.110 position:50% align:middle ECG shows normal sinus rhythm. 00:20:26.110 --> 00:20:27.870 position:50% align:middle And there's more vital signs. 00:20:27.870 --> 00:20:33.076 position:50% align:middle BP 90 over 50, pulse 116, respiration is 24, 00:20:33.076 --> 00:20:40.597 position:50% align:middle temperature 97.8 or 36.6 for our Canadian friends, and oxygen 98% on room air. 00:20:40.597 --> 00:20:42.369 position:50% align:middle Almost there. 00:20:42.369 --> 00:20:50.807 position:50% align:middle Lab results, hemoglobin 9, hematocrit 27%, white blood cell count 19,000. 00:20:50.807 --> 00:20:56.753 position:50% align:middle I want to indicate here you may see on your screen, if you're not driving, reference ranges. 00:20:56.753 --> 00:21:03.029 position:50% align:middle That's a little bit new because you probably know today, candidates are expected to have memorized 00:21:03.029 --> 00:21:06.529 position:50% align:middle reference or normal ranges for various lab values. 00:21:06.529 --> 00:21:12.681 position:50% align:middle Well, one of the things we're doing with next generation, we are trying to be more authentic, right? 00:21:12.681 --> 00:21:19.815 position:50% align:middle Well, more authentic is if 99.9% of the time when a lab result comes the reference range is printed right 00:21:19.815 --> 00:21:23.759 position:50% align:middle next to it, well, we are going to provide it in the name of authenticity. 00:21:23.759 --> 00:21:28.146 position:50% align:middle So that may be good news for students and educators. 00:21:28.146 --> 00:21:32.644 position:50% align:middle All right, let's keep going, we can finally come to the questions. 00:21:32.644 --> 00:21:35.617 position:50% align:middle So you probably noticed it took me a while to read all that. 00:21:35.617 --> 00:21:37.193 position:50% align:middle Definitely right? 00:21:37.193 --> 00:21:42.942 position:50% align:middle And that's a good thing because I think sometimes if you just skim it, you lose sight of 00:21:42.942 --> 00:21:46.700 position:50% align:middle just how much information there is, right? 00:21:46.700 --> 00:21:48.350 position:50% align:middle It's a lot of information. 00:21:48.350 --> 00:21:50.432 position:50% align:middle And what are we trying to do? 00:21:50.432 --> 00:21:55.256 position:50% align:middle Well, when the nurse educators like yourself come in and write these scenarios, we say to them, 00:21:55.256 --> 00:22:01.370 position:50% align:middle we want realistic, right, which can include things that aren't even super important, 00:22:01.370 --> 00:22:04.170 position:50% align:middle like maybe the baseball mechanically pitched, do we need to know that? 00:22:04.170 --> 00:22:05.450 position:50% align:middle I don't know, right? 00:22:05.450 --> 00:22:08.270 position:50% align:middle But that's real-world, you get all of this information. 00:22:08.270 --> 00:22:14.430 position:50% align:middle I think studies show that a nurse walking into the room may encounter thousands of cues, 00:22:14.430 --> 00:22:18.670 position:50% align:middle some of them might be pretty irrelevant, like the color of the wall or the carpet, right? 00:22:18.670 --> 00:22:24.330 position:50% align:middle But some of them might be entries in nurses' notes, or a particular lab value that isn't particularly 00:22:24.330 --> 00:22:25.950 position:50% align:middle exciting at the moment, right? 00:22:25.950 --> 00:22:31.240 position:50% align:middle Well, somehow, because we know the nurse cannot respond to all 1000 plus at the same time, 00:22:31.240 --> 00:22:37.030 position:50% align:middle somehow the nurse has to be able to say which are the most salient. 00:22:37.030 --> 00:22:38.330 position:50% align:middle Where do I start? 00:22:38.330 --> 00:22:41.380 position:50% align:middle What are the things that really jump out here, right? 00:22:41.380 --> 00:22:42.840 position:50% align:middle It can't be everything. 00:22:42.840 --> 00:22:46.000 position:50% align:middle So let's take a look in that spirit at the first item. 00:22:46.000 --> 00:22:51.830 position:50% align:middle Drag the assessment findings that require immediate follow-up to the box on the right? 00:22:51.830 --> 00:22:57.600 position:50% align:middle So again, the test taker still has all those tabs on the other side of their screen. 00:22:57.600 --> 00:23:00.320 position:50% align:middle We don't because I wanted it to be bigger, that's all. 00:23:00.320 --> 00:23:03.430 position:50% align:middle But anyways, what kind of item type is this? 00:23:03.430 --> 00:23:07.070 position:50% align:middle Today on the NCLEX, we use a format called drag and drop. 00:23:07.070 --> 00:23:11.460 position:50% align:middle Well, this is also drag and drop, but it simply has more choices. 00:23:11.460 --> 00:23:14.260 position:50% align:middle So we call it Extended Drag and Drop. 00:23:14.260 --> 00:23:15.880 position:50% align:middle That's going to be a theme you'll see. 00:23:15.880 --> 00:23:20.021 position:50% align:middle I mentioned that the item types we have today weren't really sufficient 00:23:20.021 --> 00:23:22.721 position:50% align:middle for a strong measurement of clinical judgment. 00:23:22.721 --> 00:23:28.860 position:50% align:middle In some cases, if we just added more choices, or put a little twist, it sort of got over the hump. 00:23:28.860 --> 00:23:34.900 position:50% align:middle So you'll see some item types from me that are extensions of existing item types, 00:23:34.900 --> 00:23:37.660 position:50% align:middle but you'll also see some that are brand new. 00:23:37.660 --> 00:23:41.960 position:50% align:middle Okay, so here's extended drag and drop, what's going on drag the assessment findings that 00:23:41.960 --> 00:23:43.980 position:50% align:middle require immediate follow-up to the box on the right. 00:23:43.980 --> 00:23:47.978 position:50% align:middle And we see things like productive cough, the blood pressure. 00:24:00.330 --> 00:24:01.800 position:50% align:middle Oh, gosh. 00:24:01.800 --> 00:24:04.240 position:50% align:middle Okay, it looks like I was temporarily muted. 00:24:04.240 --> 00:24:09.290 position:50% align:middle So I will go back into drag the assessment findings that require immediate follow-up to the box 00:24:09.290 --> 00:24:09.940 position:50% align:middle on the right. 00:24:09.940 --> 00:24:14.680 position:50% align:middle Productive cough, vital signs, intermediate left shoulder pain, etc. 00:24:14.680 --> 00:24:21.460 position:50% align:middle So in terms of that clinical judgment measurement model, what is really going on here? 00:24:21.460 --> 00:24:25.540 position:50% align:middle Well, that first box at layer three we call Recognize Cues. 00:24:25.540 --> 00:24:32.140 position:50% align:middle It is all about here is a lot of information, including information you probably don't need. 00:24:32.140 --> 00:24:37.160 position:50% align:middle Well, what are the things you really need to pay attention to right now, right? 00:24:37.160 --> 00:24:39.910 position:50% align:middle Can you distinguish relevant from irrelevant? 00:24:39.910 --> 00:24:42.300 position:50% align:middle Can you distinguish now from later? 00:24:42.300 --> 00:24:46.840 position:50% align:middle Can you distinguish critical from good to know, but not critical? 00:24:46.840 --> 00:24:48.420 position:50% align:middle These kinds of things. 00:24:48.420 --> 00:24:51.920 position:50% align:middle You may notice we didn't ask, what do they mean? 00:24:51.920 --> 00:24:52.950 position:50% align:middle Why are they important? 00:24:52.950 --> 00:24:56.520 position:50% align:middle And it's not because we don't care or we don't consider that critical judgment, 00:24:56.520 --> 00:24:59.640 position:50% align:middle it's simply because that's the second box, not the first. 00:24:59.640 --> 00:25:04.550 position:50% align:middle So in the first box is about recognizing or identifying these cues. 00:25:04.550 --> 00:25:07.620 position:50% align:middle When we get to the second item, it's a little more about interpreting or analyzing. 00:25:07.620 --> 00:25:10.890 position:50% align:middle So let's take a look at the second item in the set. 00:25:10.890 --> 00:25:16.370 position:50% align:middle And again, the test taker has all that information available on the other side of the screen. 00:25:16.370 --> 00:25:19.200 position:50% align:middle Nurse is reviewing the client's health history and medical record. 00:25:19.200 --> 00:25:23.540 position:50% align:middle Drag each potential issue that the client is at risk for to the box on the right. 00:25:23.540 --> 00:25:28.210 position:50% align:middle Well, I bet you recognize the item type because it's the same as the one before it, 00:25:28.210 --> 00:25:31.810 position:50% align:middle we call it Extended Drag and Drop still. 00:25:31.810 --> 00:25:34.640 position:50% align:middle Okay, well, what's going on here? 00:25:34.640 --> 00:25:42.970 position:50% align:middle We have identified or recognized the very salient cues that require the attention of that nurse, right. 00:25:42.970 --> 00:25:47.880 position:50% align:middle But now it's a little bit more about what could they mean, how do they connect together, right? 00:25:47.880 --> 00:25:51.720 position:50% align:middle How does the puzzle sort of fit together when we see these cues? 00:25:51.720 --> 00:25:53.280 position:50% align:middle That's what's going on here. 00:25:53.280 --> 00:25:55.970 position:50% align:middle In our model, we call it Analyze Cues. 00:25:55.970 --> 00:26:01.210 position:50% align:middle So it's a little bit more at the meaning or connections among those various cues. 00:26:01.210 --> 00:26:07.320 position:50% align:middle Okay, we are now approaching half time, in the case study, we've made it to item three, 00:26:07.320 --> 00:26:11.940 position:50% align:middle and we see an item that does look quite different from anything on today's exam. 00:26:11.940 --> 00:26:14.760 position:50% align:middle The nurse is initiating the client's plan of care. 00:26:14.760 --> 00:26:18.210 position:50% align:middle Complete the following sentence by using the list of options. 00:26:18.210 --> 00:26:21.770 position:50% align:middle And we see here, the nurse should first address the client's... 00:26:21.900 --> 00:26:26.890 position:50% align:middle And we have this pulldown menu with three choices like abdominal pain, respiratory status, 00:26:26.890 --> 00:26:30.060 position:50% align:middle and lab test results, followed by the client's... 00:26:30.060 --> 00:26:33.110 position:50% align:middle And then guess what the second menu is actually the same as the first. 00:26:33.110 --> 00:26:37.340 position:50% align:middle So I'm showing you one open I guess, and one closed. 00:26:37.340 --> 00:26:38.760 position:50% align:middle But anyways. 00:26:38.760 --> 00:26:42.540 position:50% align:middle So it's essentially what should we do first, what should we do next? 00:26:42.540 --> 00:26:47.600 position:50% align:middle This item type formally, right, for testing professionals, 00:26:47.600 --> 00:26:53.779 position:50% align:middle we would call it a Cloze Pull-down Menu, and that's cloze with a Z because it's a German term. 00:26:53.779 --> 00:26:58.960 position:50% align:middle But I'm happy enough just to call it pull-down menu that's what it looks like. 00:26:58.960 --> 00:27:01.210 position:50% align:middle And I think you'll be okay calling it that. 00:27:01.210 --> 00:27:03.200 position:50% align:middle So it's a pull-down menu item. 00:27:03.200 --> 00:27:06.620 position:50% align:middle But what about in terms of the Clinical Judgment Measurement Model? 00:27:06.620 --> 00:27:09.720 position:50% align:middle Well, clearly the nurse here is prioritizing. 00:27:09.720 --> 00:27:14.590 position:50% align:middle And our third box is all about prioritizing. 00:27:14.590 --> 00:27:17.570 position:50% align:middle Our full name is Prioritize Hypotheses. 00:27:17.570 --> 00:27:21.860 position:50% align:middle But I want to emphasize for this group that things can come in two different flavors. 00:27:21.860 --> 00:27:24.880 position:50% align:middle Sometimes we're prioritizing hypotheses. 00:27:24.880 --> 00:27:28.080 position:50% align:middle Oh, what's most likely happening here, for example. 00:27:28.080 --> 00:27:30.700 position:50% align:middle But sometimes I call it prioritizing conditions. 00:27:30.700 --> 00:27:36.730 position:50% align:middle If you read this first sentence evaluating and ranking hypotheses or conditions according to priority, 00:27:36.730 --> 00:27:41.570 position:50% align:middle well, if we go back to the previous item, we can see we're kind of prioritizing conditions or 00:27:41.570 --> 00:27:45.690 position:50% align:middle aspects of the client's situation, it may feel more like that than hypotheses. 00:27:45.690 --> 00:27:47.830 position:50% align:middle So again, two flavors. 00:27:47.830 --> 00:27:49.230 position:50% align:middle What unites the two? 00:27:49.230 --> 00:27:52.640 position:50% align:middle Prioritization is always step three, we're prioritizing. 00:27:52.640 --> 00:27:56.340 position:50% align:middle Okay, we now get to the second half. 00:27:56.340 --> 00:27:58.620 position:50% align:middle Now a little, I'll call it a teaching tip. 00:27:58.620 --> 00:28:04.170 position:50% align:middle It's unofficial, you can take it if you like it, you can discard it if it's just too much information. 00:28:04.170 --> 00:28:06.740 position:50% align:middle I think of a case study as having two halves. 00:28:06.740 --> 00:28:10.410 position:50% align:middle The first half of the case study is the thinking half. 00:28:10.410 --> 00:28:13.020 position:50% align:middle Okay, wow, look at all this, what's going on? 00:28:13.020 --> 00:28:14.160 position:50% align:middle That kind of thing. 00:28:14.160 --> 00:28:20.630 position:50% align:middle The second half is a little more action-oriented or intervention-oriented, it's more the doing half. 00:28:20.630 --> 00:28:22.360 position:50% align:middle So there's a thinking half and a doing half. 00:28:22.360 --> 00:28:26.090 position:50% align:middle But of course, even in the doing half, we're still thinking, 00:28:26.090 --> 00:28:29.580 position:50% align:middle right, because it's clinical judgment, clinical decision making, right? 00:28:29.580 --> 00:28:32.790 position:50% align:middle You can't do clinical judgment without some thinking. 00:28:32.790 --> 00:28:38.550 position:50% align:middle But the point is, we sort of transition into the "what are we going to do about it" phase of the case. 00:28:38.550 --> 00:28:40.262 position:50% align:middle So here we are with the fourth item. 00:28:40.262 --> 00:28:44.155 position:50% align:middle The nurse is speaking with the physician regarding the treatment plan for the client 00:28:44.155 --> 00:28:49.078 position:50% align:middle who was just diagnosed with a splenic laceration and left-sided hemothorax. 00:28:49.078 --> 00:28:56.230 position:50% align:middle So, tip for educators, sometimes candidates feel like they can skip the directions, right? 00:28:56.230 --> 00:29:00.100 position:50% align:middle The directions are just fluff, extra reading, waste of their time. 00:29:00.100 --> 00:29:02.300 position:50% align:middle Well, gosh, we just put the diagnoses here. 00:29:02.300 --> 00:29:06.930 position:50% align:middle So discourage skipping the reading. 00:29:06.930 --> 00:29:11.399 position:50% align:middle We try not to waste their time with super long directions but if we put something, 00:29:11.399 --> 00:29:13.540 position:50% align:middle it is worth reading, I would say. 00:29:13.540 --> 00:29:16.290 position:50% align:middle Okay, now let's get to what do we do? 00:29:16.290 --> 00:29:21.432 position:50% align:middle For each potential order, click to specify whether the potential order is anticipated or contraindicated 00:29:21.432 --> 00:29:22.790 position:50% align:middle for the client. 00:29:22.790 --> 00:29:26.825 position:50% align:middle Well, gosh, we can see here an item type that is not on today's NCLEX, 00:29:26.825 --> 00:29:30.380 position:50% align:middle it is brand new for the next generation NCLEX. 00:29:30.380 --> 00:29:32.830 position:50% align:middle We call it a Matrix or a Grid. 00:29:32.830 --> 00:29:36.700 position:50% align:middle It's where you put your answers into rows and columns. 00:29:36.700 --> 00:29:39.780 position:50% align:middle So simple enough if we just take it one row at a time. 00:29:39.780 --> 00:29:43.840 position:50% align:middle Potential order echocardiogram, well, would we anticipate that or would we see 00:29:43.840 --> 00:29:45.180 position:50% align:middle that as contraindicated? 00:29:45.180 --> 00:29:47.080 position:50% align:middle Okay, how about IV fluids? 00:29:47.080 --> 00:29:53.130 position:50% align:middle How about abdominal ultrasound, preparation for surgery, serum type, screen, etc. 00:29:53.130 --> 00:29:54.440 position:50% align:middle Okay. 00:29:54.440 --> 00:29:56.830 position:50% align:middle So I think you get how the item works. 00:29:56.830 --> 00:29:57.640 position:50% align:middle What's going on? 00:29:57.640 --> 00:30:04.030 position:50% align:middle Well, it's all about thinking about the client needs and asking ourselves as the nurse, 00:30:04.030 --> 00:30:09.480 position:50% align:middle what kinds of things might help, but also what kinds of things wouldn't help 00:30:09.480 --> 00:30:12.053 position:50% align:middle and might even make things worse, right? 00:30:12.130 --> 00:30:17.990 position:50% align:middle So in our clinical judgment measurement model, we're on the fourth box out of six at layer three, 00:30:17.990 --> 00:30:20.450 position:50% align:middle we call it Generate Solutions. 00:30:20.450 --> 00:30:24.410 position:50% align:middle And what I showed you, I think, is a really nice example of that. 00:30:24.410 --> 00:30:28.900 position:50% align:middle It's all about thinking about what we're hoping to accomplish, what the goals might be, 00:30:28.900 --> 00:30:33.150 position:50% align:middle and what ingredients in the plan of care might get us there. 00:30:33.150 --> 00:30:37.380 position:50% align:middle It doesn't mean we're going to or that we can do every single one of them. 00:30:37.380 --> 00:30:41.340 position:50% align:middle But it just means hey, these things at least are worth considering. 00:30:41.340 --> 00:30:45.879 position:50% align:middle And oh, by the way, here are some things we probably should avoid. 00:30:45.879 --> 00:30:51.090 position:50% align:middle Okay. We haven't yet decided exactly what we're going to do. 00:30:51.090 --> 00:30:55.810 position:50% align:middle Short story, when we started doing our writing and review panels for the next generation NCLEX, 00:30:55.810 --> 00:31:01.093 position:50% align:middle we had very experienced educators and very experienced clinicians, and they'd read the scenario 00:31:01.093 --> 00:31:04.850 position:50% align:middle without even looking at any of the questions, right. 00:31:04.850 --> 00:31:07.510 position:50% align:middle They'd say, "Oh, I know exactly what we need to do. 00:31:07.510 --> 00:31:11.540 position:50% align:middle We need to request an order for you know, an IV of whatever, and do this and 00:31:11.540 --> 00:31:12.660 position:50% align:middle prepare for surgery." 00:31:12.660 --> 00:31:18.010 position:50% align:middle And that is experienced nursing in action, right. 00:31:18.010 --> 00:31:22.280 position:50% align:middle But how did our participants know these things? 00:31:22.280 --> 00:31:26.516 position:50% align:middle Well, ultimately, there was evidence in the case in the scenario, right, 00:31:26.516 --> 00:31:29.230 position:50% align:middle there were cues that they recognized, analyzed. 00:31:29.230 --> 00:31:34.920 position:50% align:middle They had hypotheses or conditions that they prioritized. 00:31:34.920 --> 00:31:38.730 position:50% align:middle Instead of having to make a long list of possible interventions, kind of jumped to the right one. 00:31:38.730 --> 00:31:40.030 position:50% align:middle But you get the idea. 00:31:40.030 --> 00:31:44.916 position:50% align:middle It sort of sped up our process because, with experience, that's what happens. 00:31:44.980 --> 00:31:48.440 position:50% align:middle Okay, let's go to the fifth item in the set. 00:31:48.440 --> 00:31:51.710 position:50% align:middle The nurse has been asked to prepare the client for immediate surgery. 00:31:51.710 --> 00:31:54.670 position:50% align:middle Okay, so we're a little closer to exactly what we're going to do here. 00:31:54.670 --> 00:31:57.030 position:50% align:middle Which of the following action should the nurse take? 00:31:57.030 --> 00:31:58.792 position:50% align:middle You all recognize this item type. 00:31:58.792 --> 00:32:02.663 position:50% align:middle It's essentially a select all that apply. 00:32:02.663 --> 00:32:06.910 position:50% align:middle In my world, we call it multiple response. 00:32:06.910 --> 00:32:13.350 position:50% align:middle But you can see that there are extra answer choices therefore, I call it Extended Multiple Response. 00:32:13.350 --> 00:32:17.320 position:50% align:middle If you like, you can call it extended select all that apply, right? 00:32:17.320 --> 00:32:20.330 position:50% align:middle It's the item type we use today, but with more options. 00:32:20.330 --> 00:32:22.000 position:50% align:middle So what's happening here? 00:32:22.000 --> 00:32:26.835 position:50% align:middle Well, we're very focused on what to do, that is our fifth box, which is Take Action. 00:32:27.530 --> 00:32:32.900 position:50% align:middle Again, for this group, I want to emphasize two flavors of take action, right? 00:32:32.900 --> 00:32:37.310 position:50% align:middle Educators always tell me, "Jason, we'd rather you be comprehensive, 00:32:37.310 --> 00:32:43.680 position:50% align:middle even if it's a little confusing, than leave out information we need to know just to keep it simple." 00:32:43.680 --> 00:32:49.690 position:50% align:middle So here I am, I'm going to be complicated because I think ultimately, you want this information. 00:32:49.690 --> 00:32:51.710 position:50% align:middle So there are two flavors of take action. 00:32:51.710 --> 00:32:54.790 position:50% align:middle The first flavor is kind of like what you see here. 00:32:54.790 --> 00:32:56.900 position:50% align:middle It's basically, what are we going to do, right? 00:32:56.900 --> 00:33:00.050 position:50% align:middle It's a what or a which sort of question. 00:33:00.050 --> 00:33:05.700 position:50% align:middle The second flavor of take action is how, how are we going to do this? 00:33:05.700 --> 00:33:12.730 position:50% align:middle Now educators are quick to tell me that how questions really are often memorized procedures. 00:33:12.730 --> 00:33:14.470 position:50% align:middle The textbook already says how to do it. 00:33:14.470 --> 00:33:18.370 position:50% align:middle First, you wash your hands, then you open the box facing a certain way. 00:33:18.370 --> 00:33:24.780 position:50% align:middle Then you take out glove number one right, you know, tried and true step-by-step processes 00:33:24.780 --> 00:33:26.230 position:50% align:middle that students memorize. 00:33:26.230 --> 00:33:33.074 position:50% align:middle However, on the next generation NCLEX in a case study, if there is a how 00:33:33.074 --> 00:33:36.620 position:50% align:middle it means there is something non-routine here, 00:33:36.620 --> 00:33:42.780 position:50% align:middle a little bit of a curveball to keep with the mechanically pitched baseball analogy here. 00:33:42.780 --> 00:33:43.950 position:50% align:middle What do I mean by that? 00:33:43.950 --> 00:33:49.500 position:50% align:middle So pretend that somewhere in this scenario, there are cues that suggest the client may 00:33:49.500 --> 00:33:51.820 position:50% align:middle have difficulty swallowing. 00:33:51.820 --> 00:33:58.430 position:50% align:middle But pretend that they need a medication that's usually administered orally. 00:33:58.430 --> 00:34:02.320 position:50% align:middle Well, the how isn't just give them the pill and tell them to swallow it, right? 00:34:02.320 --> 00:34:03.670 position:50% align:middle It's a little different. 00:34:03.670 --> 00:34:09.120 position:50% align:middle I don't want to pretend that's a super hard challenge for nurses but you get the idea. 00:34:09.120 --> 00:34:14.100 position:50% align:middle If there's a how it connects definitely to information in the scenario. 00:34:14.100 --> 00:34:20.530 position:50% align:middle When we pulled our item review panels if there's a how we say, hey, tell us if this is a memorized procedure, 00:34:20.530 --> 00:34:22.100 position:50% align:middle then we don't want it, right. 00:34:22.100 --> 00:34:25.464 position:50% align:middle We want to make sure that the how involves clinical judgment. 00:34:26.960 --> 00:34:30.070 position:50% align:middle Ready for the sixth and final item in the case study? 00:34:30.070 --> 00:34:34.040 position:50% align:middle Pay careful attention because you are going to be writing some of these with me, believe it or not, 00:34:34.040 --> 00:34:37.230 position:50% align:middle in just...I think in just a few minutes. 00:34:37.230 --> 00:34:38.620 position:50% align:middle So here we go. 00:34:38.620 --> 00:34:42.120 position:50% align:middle Final item in the set, click to highlight the findings below that would 00:34:42.120 --> 00:34:46.220 position:50% align:middle indicate the client is not progressing as expected. 00:34:46.220 --> 00:34:51.980 position:50% align:middle And the way this works, just like it says, is I can click on something and it highlights. 00:34:51.980 --> 00:34:54.520 position:50% align:middle I can click on something else and it highlights. 00:34:54.520 --> 00:34:58.450 position:50% align:middle I can click again and it unhighlights if I change my mind. 00:34:58.450 --> 00:35:01.689 position:50% align:middle But the point is we are literally highlighting. 00:35:01.689 --> 00:35:02.570 position:50% align:middle Good news. 00:35:02.570 --> 00:35:08.699 position:50% align:middle The student, the graduate, the test taker, doesn't have to spend any mental energy deciding 00:35:08.699 --> 00:35:12.239 position:50% align:middle do I just say refusing to use the spirometer? 00:35:12.239 --> 00:35:15.470 position:50% align:middle Do I need to include stating it causes pain? 00:35:15.470 --> 00:35:16.920 position:50% align:middle Do I say the client is. 00:35:16.920 --> 00:35:18.670 position:50% align:middle No, we have pre-programmed these. 00:35:18.670 --> 00:35:23.150 position:50% align:middle If they click on any part of the correct response, or even the incorrect response, 00:35:23.150 --> 00:35:25.680 position:50% align:middle if they click on any part, they get the whole thing. 00:35:25.680 --> 00:35:30.940 position:50% align:middle So they don't even have to decide word by word, they just need the basic concept here. 00:35:30.940 --> 00:35:33.360 position:50% align:middle Okay, well, what's going on? 00:35:33.360 --> 00:35:35.440 position:50% align:middle The name of this item probably won't shock you. 00:35:35.440 --> 00:35:37.300 position:50% align:middle We call it a highlighting item. 00:35:37.300 --> 00:35:43.980 position:50% align:middle In terms of Clinical Judgment Measurement Model, this is all about evaluation in the nursing process, 00:35:43.980 --> 00:35:48.690 position:50% align:middle or in our model, we say evaluate outcomes, right. 00:35:48.690 --> 00:35:55.270 position:50% align:middle So typical evaluate outcomes is we essentially have a before and after of our client. 00:35:55.270 --> 00:35:58.600 position:50% align:middle The before is kind of when we first showed up as the nurse. 00:35:58.600 --> 00:36:02.480 position:50% align:middle The after is after some interventions have been performed. 00:36:02.480 --> 00:36:08.340 position:50% align:middle Well, we had a bunch of findings before, we get some new findings after, right? 00:36:08.340 --> 00:36:12.440 position:50% align:middle And we need to be able to recognize, okay, are all these good news? 00:36:12.440 --> 00:36:13.920 position:50% align:middle Are any of them bad news? 00:36:13.920 --> 00:36:17.180 position:50% align:middle Do some of them indicate that an intervention might have been ineffective? 00:36:17.180 --> 00:36:20.770 position:50% align:middle Do some of them indicate maybe I should have done something else, right? 00:36:20.770 --> 00:36:24.590 position:50% align:middle So evaluate outcomes is how all of these finish. 00:36:24.590 --> 00:36:30.910 position:50% align:middle So congratulate yourselves, you made it through the absolute most dense part 00:36:30.910 --> 00:36:34.640 position:50% align:middle of this presentation, which is to get through an entire case study, 00:36:34.640 --> 00:36:40.250 position:50% align:middle not just to look at the questions, but to connect them with the Clinical Judgment 00:36:40.250 --> 00:36:42.190 position:50% align:middle Measurement Model, right? 00:36:42.190 --> 00:36:44.060 position:50% align:middle We got to connect those dots. 00:36:44.060 --> 00:36:50.420 position:50% align:middle So key features of the case study real-world situations, we require that of our item writers. 00:36:50.420 --> 00:36:53.600 position:50% align:middle Educators, just like you give us real-world. 00:36:53.600 --> 00:36:59.050 position:50% align:middle Okay, well, that always includes some information that the candidate will not need, 00:36:59.050 --> 00:37:00.710 position:50% align:middle right but that's real world. 00:37:00.710 --> 00:37:05.900 position:50% align:middle Real-world nobody ever says to you, as the nurse, here are the only three things you need to know. 00:37:05.900 --> 00:37:07.580 position:50% align:middle Now you know what to do, right? 00:37:07.580 --> 00:37:11.110 position:50% align:middle Well, real-world, you've got the notes from the prior nurse, you've got, you know, 00:37:11.110 --> 00:37:15.640 position:50% align:middle any sort of visual or physical assessment that you've done, you might have vital signs, hopefully, 00:37:15.640 --> 00:37:16.760 position:50% align:middle right, lab results. 00:37:16.760 --> 00:37:21.480 position:50% align:middle Yeah, all this information, some of it you don't need right now, that's real life. 00:37:21.480 --> 00:37:24.830 position:50% align:middle Okay, two progressions, one a progression through time. 00:37:24.830 --> 00:37:27.606 position:50% align:middle This isn't just a snapshot of the client right now. 00:37:27.606 --> 00:37:29.356 position:50% align:middle I mentioned the before and after. 00:37:29.356 --> 00:37:33.490 position:50% align:middle In some case studies...in fact, there's one I presented a couple of weeks ago, 00:37:33.490 --> 00:37:37.361 position:50% align:middle where we followed the client around for three weeks because they came back after two weeks 00:37:37.361 --> 00:37:39.660 position:50% align:middle for some sort of checkup or something like that. 00:37:39.660 --> 00:37:46.360 position:50% align:middle But the point is, we are following the client through some significant amount of time where they walk in one 00:37:46.360 --> 00:37:53.102 position:50% align:middle way or were brought in one way, interventions happened, they now are a little bit different, right? 00:37:53.102 --> 00:37:54.050 position:50% align:middle This takes time. 00:37:54.050 --> 00:38:02.180 position:50% align:middle But also it was a progression in terms of our layer three of the Clinical Judgment Measurement Model. 00:38:02.180 --> 00:38:05.140 position:50% align:middle Here's what I want you to know, here's an important takeaway. 00:38:05.140 --> 00:38:08.950 position:50% align:middle You may have just looked at this case study and said, oh, boy, some of these items are a 00:38:08.950 --> 00:38:10.470 position:50% align:middle little bit complicated. 00:38:10.470 --> 00:38:12.030 position:50% align:middle I'm not going to differ with you, right? 00:38:12.030 --> 00:38:17.796 position:50% align:middle And clinical judgment, in some sense, almost requires complicated situations. 00:38:18.580 --> 00:38:23.970 position:50% align:middle However, what I don't want you to walk away with is oh, wow, the case study is a whole bunch 00:38:23.970 --> 00:38:25.920 position:50% align:middle of random complicated questions. 00:38:25.920 --> 00:38:26.780 position:50% align:middle Yikes. 00:38:26.780 --> 00:38:27.730 position:50% align:middle Don't think that. 00:38:27.730 --> 00:38:29.780 position:50% align:middle It is always six questions. 00:38:29.780 --> 00:38:36.510 position:50% align:middle They are always in the order of those six boxes, starting with recognize cues finishing 00:38:36.510 --> 00:38:38.130 position:50% align:middle with evaluate outcomes, right? 00:38:38.130 --> 00:38:40.100 position:50% align:middle So not random at all, right? 00:38:40.100 --> 00:38:43.970 position:50% align:middle The first question always is here's a lot of information. 00:38:43.970 --> 00:38:46.710 position:50% align:middle Pick out the things that matter right now, right? 00:38:46.710 --> 00:38:48.930 position:50% align:middle It may be worded different but essentially, that's it. 00:38:48.930 --> 00:38:52.030 position:50% align:middle The second question is always, okay, why do we care? 00:38:52.030 --> 00:38:53.350 position:50% align:middle Or how do these things fit together? 00:38:53.350 --> 00:38:54.490 position:50% align:middle What do they mean, right? 00:38:54.490 --> 00:38:55.470 position:50% align:middle Some level of analysis. 00:38:55.470 --> 00:38:57.120 position:50% align:middle So definitely not random. 00:38:57.120 --> 00:39:03.490 position:50% align:middle Those six boxes in order are the blueprint for every single case study on the exam. 00:39:03.490 --> 00:39:05.030 position:50% align:middle What else? 00:39:05.030 --> 00:39:07.980 position:50% align:middle Well, you saw this, a range of content knowledge. 00:39:07.980 --> 00:39:11.520 position:50% align:middle To do well in that case study, to do really well, 00:39:11.520 --> 00:39:14.090 position:50% align:middle you would need to know a lot of different things, right? 00:39:14.090 --> 00:39:17.870 position:50% align:middle In a multiple-choice item, you might get lucky and know the one thing 00:39:17.870 --> 00:39:24.380 position:50% align:middle that's needed, but in this case, to do really well, you need to know a lot of different things. 00:39:24.380 --> 00:39:26.490 position:50% align:middle You saw some new item types. 00:39:26.490 --> 00:39:29.330 position:50% align:middle And again, they came in two flavors. 00:39:29.330 --> 00:39:35.419 position:50% align:middle Some were just extensions of item types we already have such as extended multiple response 00:39:35.419 --> 00:39:37.290 position:50% align:middle and extended drag and drop. 00:39:37.290 --> 00:39:41.610 position:50% align:middle Others were genuinely new item types for this exam. 00:39:41.610 --> 00:39:46.558 position:50% align:middle You saw the pull-down menu, you saw highlighting and you saw matrix or grid. 00:39:48.310 --> 00:39:50.090 position:50% align:middle So here we go. 00:39:50.090 --> 00:39:51.930 position:50% align:middle We are going to try one together. 00:39:51.930 --> 00:39:56.498 position:50% align:middle If you have already downloaded our spring 2020 newsletter turn it upside down 00:39:56.498 --> 00:39:59.170 position:50% align:middle because the answers are in the newsletter. 00:39:59.170 --> 00:40:03.880 position:50% align:middle I have taken a sample from that newsletter and turned it into an interactive exercise. 00:40:03.880 --> 00:40:07.470 position:50% align:middle You will be using the chat, which by the way, I can see is super active. 00:40:07.470 --> 00:40:10.790 position:50% align:middle I'm going to get to these questions, I hope all at the end. 00:40:10.790 --> 00:40:17.510 position:50% align:middle But for now, we're also going to use the chat to complete this item set in a nice interactive manner. 00:40:17.510 --> 00:40:23.950 position:50% align:middle Feel free if Zoom lets you to like or comment on other people's ideas or if not, 00:40:23.950 --> 00:40:26.690 position:50% align:middle just use the chat for your own ideas. 00:40:26.690 --> 00:40:29.650 position:50% align:middle Okay, let's go into it. 00:40:29.650 --> 00:40:33.270 position:50% align:middle So we have a new scenario, again, in case you're driving or on a small screen, 00:40:33.270 --> 00:40:34.600 position:50% align:middle I will read it. 00:40:34.600 --> 00:40:39.820 position:50% align:middle The nurse is caring for a 78-year-old female in the emergency department and there's only one tab. 00:40:39.820 --> 00:40:41.810 position:50% align:middle I mentioned before we had four tabs. 00:40:41.810 --> 00:40:44.830 position:50% align:middle That's not a magic number, could just be one. 00:40:44.830 --> 00:40:45.840 position:50% align:middle Okay. 00:40:45.840 --> 00:40:49.950 position:50% align:middle Client was brought to the ED by her daughter due to increased shortness of breath. 00:40:49.950 --> 00:40:52.190 position:50% align:middle You're probably thinking COVID already. 00:40:52.190 --> 00:40:55.150 position:50% align:middle This was written even before the pandemic. 00:40:55.150 --> 00:40:57.920 position:50% align:middle So anyway, but okay, increased shortness of breath this morning. 00:40:57.920 --> 00:41:02.280 position:50% align:middle Daughter reports the client has been running a fever for the past few days and has started to cough 00:41:02.280 --> 00:41:06.380 position:50% align:middle up greenish-colored mucus and to complain of soreness throughout her body. 00:41:06.380 --> 00:41:10.390 position:50% align:middle Client recently hospitalized for issues with afib six days ago. 00:41:10.390 --> 00:41:13.450 position:50% align:middle Client has a history of hypertension. 00:41:13.450 --> 00:41:20.025 position:50% align:middle Vitals are 101.1, 92 pulse, 22 respiration, blood pressure 152 over 86, 00:41:20.025 --> 00:41:25.211 position:50% align:middle pulse ox 94 with two liters per minute via nasal cannula. 00:41:25.211 --> 00:41:28.661 position:50% align:middle Upon assessment, breathing appears slightly labored. 00:41:28.661 --> 00:41:31.428 position:50% align:middle Coarse crackles noted in bilateral lung bases. 00:41:31.428 --> 00:41:34.594 position:50% align:middle Skin slightly cool to touch, pale pink in tone. 00:41:34.594 --> 00:41:36.231 position:50% align:middle Pulse plus 3 and irregular. 00:41:36.231 --> 00:41:38.260 position:50% align:middle Cap refill three seconds. 00:41:38.260 --> 00:41:40.532 position:50% align:middle Client alert, oriented person, place, and time. 00:41:40.532 --> 00:41:45.368 position:50% align:middle The client's daughter states "Sometimes it seems like my mother is confused." 00:41:45.368 --> 00:41:46.650 position:50% align:middle So that's our information. 00:41:46.650 --> 00:41:52.545 position:50% align:middle Now, let's recognize cues item together. 00:41:52.545 --> 00:41:56.999 position:50% align:middle Rather than giving you a blank sheet of paper...and by the way, I have a training. 00:41:56.999 --> 00:41:59.030 position:50% align:middle We call it our Action Model Training. 00:41:59.030 --> 00:42:02.910 position:50% align:middle But it's a long training, it's roughly a half-day training which I'm always 00:42:02.910 --> 00:42:03.490 position:50% align:middle willing to do. 00:42:03.490 --> 00:42:07.750 position:50% align:middle But the point is, I don't have a half a day for you right in this one. 00:42:07.750 --> 00:42:13.303 position:50% align:middle So rather than start you with a blank sheet of paper, pardon me, we are going to start with an item 00:42:13.303 --> 00:42:17.800 position:50% align:middle mostly written and we are going to essentially fill in the blanks. 00:42:17.800 --> 00:42:23.700 position:50% align:middle So we got all that information about the 78-year-old female, drag the top four client findings that would 00:42:23.700 --> 00:42:26.160 position:50% align:middle require follow-up to the box on the right. 00:42:26.160 --> 00:42:28.310 position:50% align:middle So we see an extended drag and drop. 00:42:28.310 --> 00:42:33.180 position:50% align:middle And let's now think like an item writer since that's what we're doing, right? 00:42:33.180 --> 00:42:36.620 position:50% align:middle Less like a nurse, less like an educator, more like an item writer. 00:42:36.620 --> 00:42:44.810 position:50% align:middle Well, we can tell the logic of this item is that we need four correct answers and two that are incorrect. 00:42:44.810 --> 00:42:48.180 position:50% align:middle So we are going to use the chat here. 00:42:48.180 --> 00:42:52.995 position:50% align:middle You tell me, type in, just give me one for now. 00:42:52.995 --> 00:42:54.850 position:50% align:middle Productive cough, okay. 00:42:54.850 --> 00:42:56.660 position:50% align:middle Dr. Gina is already on it. 00:42:56.660 --> 00:42:57.198 position:50% align:middle Fever. 00:42:57.198 --> 00:42:58.469 position:50% align:middle Oh my gosh, you guys get the drill 00:42:58.469 --> 00:42:59.687 position:50% align:middle I didn't even finish my direction. 00:42:59.687 --> 00:43:00.710 position:50% align:middle But no, you got it. 00:43:00.710 --> 00:43:01.740 position:50% align:middle Tell me something. 00:43:01.740 --> 00:43:06.320 position:50% align:middle Anything in the findings, anything in the scenario that you believe requires immediate follow-up? 00:43:06.320 --> 00:43:09.720 position:50% align:middle We're focusing only on correct ones right now, okay. 00:43:09.720 --> 00:43:11.560 position:50% align:middle Yeah, I am seeing all kinds of things. 00:43:11.560 --> 00:43:17.050 position:50% align:middle Greenish sputum, confused, crackles, yes, okay. 00:43:17.050 --> 00:43:18.750 position:50% align:middle This is an amazing group. 00:43:18.750 --> 00:43:20.340 position:50% align:middle This group just set a record. 00:43:20.340 --> 00:43:22.520 position:50% align:middle Oxygen saturation, love it. 00:43:22.520 --> 00:43:25.746 position:50% align:middle Okay, now, take a quick break. 00:43:25.746 --> 00:43:27.239 position:50% align:middle We're going to make a quick shift. 00:43:27.239 --> 00:43:29.500 position:50% align:middle We need our item to have wrong answers. 00:43:29.500 --> 00:43:33.570 position:50% align:middle In other words, if I just took six things that you told me, that would be a weird item, 00:43:33.570 --> 00:43:38.370 position:50% align:middle because it says drag the top four, but we don't want them all to be tied for first. 00:43:38.370 --> 00:43:45.930 position:50% align:middle So now find some things in the scenario that don't require follow-up. 00:43:45.930 --> 00:43:49.370 position:50% align:middle Do I have some information here that doesn't require follow-up? 00:43:49.370 --> 00:43:50.458 position:50% align:middle And be careful. 00:43:50.458 --> 00:43:54.223 position:50% align:middle We prefer for it not to be too obvious, right? 00:43:57.872 --> 00:44:01.191 position:50% align:middle Example, let me see if I see something here. 00:44:01.280 --> 00:44:06.680 position:50% align:middle Yeah, alert to person, place, and time may be a little bit too obvious, right? 00:44:06.680 --> 00:44:07.610 position:50% align:middle That just sounds great. 00:44:07.610 --> 00:44:10.218 position:50% align:middle Or if it ever said you know, breathing is normal, 00:44:10.218 --> 00:44:14.030 position:50% align:middle that might not be a great answer choice because it's too obvious. 00:44:14.030 --> 00:44:14.720 position:50% align:middle But what am I seeing? 00:44:14.720 --> 00:44:20.620 position:50% align:middle Cap refill, soreness, yeah, alert, oriented. 00:44:20.620 --> 00:44:21.910 position:50% align:middle I am seeing terrific things. 00:44:21.910 --> 00:44:23.530 position:50% align:middle History of hypertension. 00:44:23.530 --> 00:44:24.380 position:50% align:middle Beautiful. 00:44:24.380 --> 00:44:25.430 position:50% align:middle This group gets it. 00:44:25.430 --> 00:44:27.120 position:50% align:middle Okay, here comes the big reveal. 00:44:27.120 --> 00:44:30.970 position:50% align:middle But I need to emphasize, when I show you what the item writer came up with, 00:44:30.970 --> 00:44:33.100 position:50% align:middle it doesn't mean it's better than yours, right? 00:44:33.100 --> 00:44:34.430 position:50% align:middle It definitely doesn't mean it's better. 00:44:34.430 --> 00:44:38.615 position:50% align:middle It might be different, although what you're going to see is that a lot of what you suggested, 00:44:38.615 --> 00:44:40.740 position:50% align:middle in fact, is what the item writer went with. 00:44:40.740 --> 00:44:44.239 position:50% align:middle So fans of "Family Feud" in the audience depending on your age, 00:44:44.239 --> 00:44:50.010 position:50% align:middle I'm either Steve Harvey without the funny jokes or Richard Dawson without the kisses. 00:44:50.010 --> 00:44:54.543 position:50% align:middle I am now going to reveal survey says and here's what we got. 00:44:54.850 --> 00:44:59.700 position:50% align:middle Vital signs, lung sounds, cap refill, orientation, radial pulse characteristics, 00:44:59.700 --> 00:45:01.200 position:50% align:middle and cough characteristics. 00:45:01.200 --> 00:45:03.650 position:50% align:middle That's what the item writer choose. 00:45:03.650 --> 00:45:08.470 position:50% align:middle Now, let me emphasize, in case you write one of these yourself ever, 00:45:08.470 --> 00:45:16.110 position:50% align:middle right, the way to approach the item logically, I believe, is to write the four right answers, 00:45:16.110 --> 00:45:18.790 position:50% align:middle and then write the two wrong answers, right? 00:45:18.790 --> 00:45:20.750 position:50% align:middle You know, think logically, right? 00:45:20.750 --> 00:45:22.392 position:50% align:middle Break it down into the two parts. 00:45:22.392 --> 00:45:25.226 position:50% align:middle We need some keys, and we need some distractors in testing language. 00:45:25.226 --> 00:45:29.923 position:50% align:middle However, in your final form, don't list them in that order 00:45:29.923 --> 00:45:34.310 position:50% align:middle or everyone starts to figure out oh, the first ones are right, the last ones are wrong, 00:45:34.310 --> 00:45:35.550 position:50% align:middle right, you don't want to do that. 00:45:35.550 --> 00:45:37.530 position:50% align:middle So we like to shuffle them. 00:45:37.530 --> 00:45:42.460 position:50% align:middle And you can kind of tell looking at the choices here, we've shuffled them from shortest to longest, right? 00:45:42.460 --> 00:45:45.790 position:50% align:middle So the correct ones could be anywhere, the incorrect ones could be anywhere. 00:45:45.790 --> 00:45:47.270 position:50% align:middle Great job, this group. 00:45:47.270 --> 00:45:52.780 position:50% align:middle Guess what, though I have five more and some of them are even a little bit more complicated. 00:45:52.780 --> 00:45:54.810 position:50% align:middle This one is a really cool item type. 00:45:54.810 --> 00:45:57.970 position:50% align:middle It's a use of our matrix grid in a little bit of a novel way. 00:45:57.970 --> 00:46:01.030 position:50% align:middle Let me move things over so I can see the whole thing. 00:46:01.030 --> 00:46:01.767 position:50% align:middle Well, here's what it says. 00:46:01.767 --> 00:46:08.713 position:50% align:middle for each client findingt below, click to specify if the finding is consistent with the disease process of... 00:46:08.713 --> 00:46:11.550 position:50% align:middle and I've covered up what the item writer went with. 00:46:11.550 --> 00:46:15.780 position:50% align:middle But they've listed three conditions, right, three conditions. 00:46:15.780 --> 00:46:20.240 position:50% align:middle So we're going to put our focus there first. 00:46:20.240 --> 00:46:26.350 position:50% align:middle So in the chatbox, tell me some conditions...it doesn't mean the client definitely has this, right. 00:46:26.350 --> 00:46:29.150 position:50% align:middle And we know that's not the role of the nurse anyways. 00:46:29.150 --> 00:46:33.023 position:50% align:middle But what are some things where at least some of the cues might have something in common 00:46:33.023 --> 00:46:35.120 position:50% align:middle with the condition you type in? 00:46:35.120 --> 00:46:36.212 position:50% align:middle I'm seeing pneumonia. 00:46:36.212 --> 00:46:37.216 position:50% align:middle I love it. 00:46:37.216 --> 00:46:39.580 position:50% align:middle Okay, I'm seeing a lot of pneumonia. 00:46:39.580 --> 00:46:40.210 position:50% align:middle What else do I have? 00:46:40.210 --> 00:46:41.160 position:50% align:middle I have CHF. 00:46:41.160 --> 00:46:46.370 position:50% align:middle I will be honest and say I'm not sure what that is, but I'll take it. 00:46:46.370 --> 00:46:46.870 position:50% align:middle Okay. 00:46:46.870 --> 00:46:49.220 position:50% align:middle Sepsis. 00:46:49.220 --> 00:46:51.060 position:50% align:middle Okay. 00:46:51.060 --> 00:46:52.830 position:50% align:middle Let's see aspiration. 00:46:52.830 --> 00:46:55.740 position:50% align:middle Okay, so I'm seeing quite a few things. 00:46:55.740 --> 00:46:58.390 position:50% align:middle Looks like septicemia if I'm reading that right. 00:46:58.390 --> 00:46:59.490 position:50% align:middle Plenty of pneumonia. 00:46:59.490 --> 00:47:02.320 position:50% align:middle I think pneumonia is really jumping off the page for this group. 00:47:02.320 --> 00:47:04.670 position:50% align:middle And I think the item writer went with that as well. 00:47:04.670 --> 00:47:06.020 position:50% align:middle So let me reveal. 00:47:06.020 --> 00:47:07.890 position:50% align:middle Oh, COPD, okay. 00:47:07.890 --> 00:47:09.100 position:50% align:middle RSV, right. 00:47:09.100 --> 00:47:11.450 position:50% align:middle These days, I might say COVID. 00:47:11.450 --> 00:47:13.690 position:50% align:middle But let's see what the item writer went with. 00:47:13.690 --> 00:47:17.180 position:50% align:middle Pneumonia, UTI, and influenza. 00:47:17.180 --> 00:47:20.490 position:50% align:middle Congestive heart failure, okay, that's important for me to know. 00:47:20.490 --> 00:47:21.550 position:50% align:middle Thank you, Brandy. 00:47:21.550 --> 00:47:25.660 position:50% align:middle Okay, so that's half the item is these headings, right? 00:47:25.660 --> 00:47:31.010 position:50% align:middle What are some diseases or illnesses that would be interesting to consider 00:47:31.010 --> 00:47:33.870 position:50% align:middle against the client findings right? 00:47:33.870 --> 00:47:37.798 position:50% align:middle Well, what are some client findings that we'd be interested to bounce up against 00:47:37.798 --> 00:47:40.927 position:50% align:middle these conditions, right? 00:47:40.927 --> 00:47:46.080 position:50% align:middle So here, it's a little bit of a free for all, because we've got five things, 00:47:46.080 --> 00:47:51.100 position:50% align:middle and there's sort of the notion of a key or distractor is a little different than usual because you're 00:47:51.100 --> 00:47:55.160 position:50% align:middle probably going to find something that ends up being right for let's say, 00:47:55.160 --> 00:47:57.490 position:50% align:middle two of these conditions and not right for one. 00:47:57.490 --> 00:47:59.170 position:50% align:middle So things are a little blurrier here. 00:47:59.170 --> 00:48:02.940 position:50% align:middle But what are some findings where it would be interesting, you'd want to know. 00:48:02.940 --> 00:48:06.610 position:50% align:middle Do my students connect this symptom or finding with pneumonia? 00:48:06.610 --> 00:48:08.720 position:50% align:middle Do they connect it with UTI, right? 00:48:08.720 --> 00:48:11.300 position:50% align:middle It doesn't have to go with all three, it doesn't even have to go with any. 00:48:11.300 --> 00:48:15.130 position:50% align:middle But what's interesting, fever cough, abnormal breath sounds, pneumonia. 00:48:15.130 --> 00:48:20.250 position:50% align:middle Yeah, okay go with pneumonia, body aches, elevated temperature, labored breathing. 00:48:20.250 --> 00:48:22.150 position:50% align:middle Okay, this group is doing a great job. 00:48:22.150 --> 00:48:23.560 position:50% align:middle Abnormal sputum. 00:48:23.560 --> 00:48:25.280 position:50% align:middle Okay, I like it. 00:48:25.280 --> 00:48:27.700 position:50% align:middle SAT, I'm guessing the oxygen. 00:48:27.700 --> 00:48:31.250 position:50% align:middle Okay, good. 00:48:31.250 --> 00:48:33.820 position:50% align:middle Let's see what the item writer came up with here. 00:48:33.820 --> 00:48:36.850 position:50% align:middle Okay, UTI would be good for fever and confusion. 00:48:36.850 --> 00:48:37.480 position:50% align:middle Excellent. 00:48:37.480 --> 00:48:39.400 position:50% align:middle Confusion would be a great choice. 00:48:39.400 --> 00:48:44.970 position:50% align:middle Fever would be a great choice and would probably check off all three illnesses. 00:48:44.970 --> 00:48:47.370 position:50% align:middle So let's see what the item writer did. 00:48:47.370 --> 00:48:52.470 position:50% align:middle Much of what you've mentioned, I think fever, confusion, soreness, cough, and sputum, 00:48:52.470 --> 00:48:53.740 position:50% align:middle shortness of breath. 00:48:53.740 --> 00:48:54.590 position:50% align:middle Beautiful. 00:48:54.590 --> 00:48:58.570 position:50% align:middle I think you all pretty much wrote the same item in a way. 00:48:58.570 --> 00:48:59.690 position:50% align:middle So this is nice. 00:48:59.690 --> 00:49:02.810 position:50% align:middle Nothing magic, by the way about the number of rows. 00:49:02.810 --> 00:49:07.100 position:50% align:middle If you said, oh, gosh, I had a sixth client finding I really, really wanted. 00:49:07.100 --> 00:49:10.970 position:50% align:middle Hey, great, add it, add it to the list, it's okay, right? 00:49:10.970 --> 00:49:16.547 position:50% align:middle Or if you said, gosh, this is a really great question to ask for pneumonia and UTI, 00:49:16.547 --> 00:49:18.520 position:50% align:middle but it's not a good question for influenza. 00:49:18.520 --> 00:49:20.920 position:50% align:middle That's okay, get rid of influenza, you know what I'm saying? 00:49:20.920 --> 00:49:27.200 position:50% align:middle So these templates that I'm showing you, right, at NCSBN, we've released some sample items to the public, 00:49:27.200 --> 00:49:31.660 position:50% align:middle like in the newsletter, June 2020 newsletter, you're getting this full set, right? 00:49:31.660 --> 00:49:37.130 position:50% align:middle The point is, rather than start from a blank page with my action model training, 00:49:37.130 --> 00:49:42.310 position:50% align:middle you can take these items and modify them for a new scenario. 00:49:42.310 --> 00:49:43.821 position:50% align:middle And you don't have to start from scratch, 00:49:43.821 --> 00:49:47.338 position:50% align:middle You can say I like this item type, now let me change it to fit what I've got. 00:49:47.338 --> 00:49:48.530 position:50% align:middle Okay. 00:49:49.160 --> 00:49:51.504 position:50% align:middle Let's go to prioritize hypotheses. 00:49:52.440 --> 00:49:55.860 position:50% align:middle So same client, highest risk for developing what? 00:49:55.860 --> 00:49:59.975 position:50% align:middle And then it says as evidenced by the client's something else. 00:50:00.070 --> 00:50:03.450 position:50% align:middle So let's break it down like an item writer, let's think logically. 00:50:03.450 --> 00:50:07.390 position:50% align:middle When it says the client is at highest risk for developing something, well, 00:50:07.390 --> 00:50:11.294 position:50% align:middle we need a key in the pull-down menu, and we need distractors. 00:50:11.294 --> 00:50:13.071 position:50% align:middle So let's go in order. 00:50:13.071 --> 00:50:17.145 position:50% align:middle What do you think the client is at highest risk for developing? 00:50:17.145 --> 00:50:23.110 position:50% align:middle And spoiler alert most groups have a few answers. 00:50:23.110 --> 00:50:28.990 position:50% align:middle I would say there's a little bit of disagreement here so don't worry, don't be scared to type in your idea. 00:50:28.990 --> 00:50:30.621 position:50% align:middle We do get disagreement here, 00:50:30.621 --> 00:50:33.730 position:50% align:middle which makes me want to talk to my team and see what they thought it was. 00:50:33.730 --> 00:50:39.100 position:50% align:middle But at any rate, okay, sepsis, pneumonia. 00:50:39.100 --> 00:50:41.000 position:50% align:middle Yeah, sepsis and pneumonia. 00:50:41.000 --> 00:50:42.340 position:50% align:middle Okay, great. 00:50:42.340 --> 00:50:47.630 position:50% align:middle So now, what are some things that the client is not at highest risk for developing? 00:50:47.630 --> 00:50:51.980 position:50% align:middle Maybe they're at no risk, or they're at very low risk based on this information. 00:50:51.980 --> 00:50:53.930 position:50% align:middle Let's get some distractors. 00:50:53.930 --> 00:50:55.370 position:50% align:middle Okay. 00:50:55.370 --> 00:50:56.410 position:50% align:middle Deborah, I apologize. 00:50:56.410 --> 00:51:01.440 position:50% align:middle Respiratory failure I don't know if that was a key or distractor but I like it as a choice either way. 00:51:01.440 --> 00:51:04.300 position:50% align:middle I'm seeing ARDS from Dr. Gina. 00:51:04.300 --> 00:51:05.770 position:50% align:middle Anything else as a distractor? 00:51:05.770 --> 00:51:10.453 position:50% align:middle What is the client not at risk for or at least at a much lower risk of? 00:51:11.850 --> 00:51:13.913 position:50% align:middle Let's see if we're going to get two more. 00:51:20.450 --> 00:51:21.520 position:50% align:middle Okay, love it. 00:51:21.520 --> 00:51:23.040 position:50% align:middle Here we go, diabetes. 00:51:23.040 --> 00:51:24.450 position:50% align:middle Okay, low risk of UTI. 00:51:24.450 --> 00:51:26.590 position:50% align:middle Hypertensive emergency. 00:51:26.590 --> 00:51:27.420 position:50% align:middle Love it. 00:51:27.420 --> 00:51:28.180 position:50% align:middle Excellent job. 00:51:28.180 --> 00:51:31.070 position:50% align:middle Let's see what the item writer did before we go to the second thing. 00:51:31.070 --> 00:51:35.980 position:50% align:middle The item writer went with hypoxia, stroke, dysrhythmias, and pulmonary embolism. 00:51:35.980 --> 00:51:41.110 position:50% align:middle Okay, as evidenced by...now, again, this is thinking like an item writer. 00:51:41.110 --> 00:51:42.731 position:50% align:middle Be careful here. 00:51:42.731 --> 00:51:46.620 position:50% align:middle Well, obviously, we are looking for evidence, right? 00:51:46.620 --> 00:51:51.870 position:50% align:middle We think they're at highest risk for a pulmonary embolism because of x, right? 00:51:51.870 --> 00:51:53.350 position:50% align:middle Or maybe it's not pulmonary embolism. 00:51:53.350 --> 00:51:55.610 position:50% align:middle But whatever it is, right, we're looking for evidence. 00:51:55.610 --> 00:52:00.000 position:50% align:middle However, pretend the answer here were pulmonary embolism. 00:52:00.000 --> 00:52:04.710 position:50% align:middle As a non-nurse, I don't know what it is, but pretend it's pulmonary embolism. 00:52:04.710 --> 00:52:12.040 position:50% align:middle If all of the findings we list really point hard to pulmonary embolism and don't point at all 00:52:12.040 --> 00:52:15.740 position:50% align:middle to anything else, you have now given a big hint, right? 00:52:15.740 --> 00:52:21.401 position:50% align:middle When candidates or students open that second menu, and let's say every single thing 00:52:21.401 --> 00:52:25.840 position:50% align:middle has to do with, like, blood clots or something, right? 00:52:25.840 --> 00:52:28.540 position:50% align:middle They're going to say, oh, maybe I better change my answer, 00:52:28.540 --> 00:52:29.800 position:50% align:middle I thought it was dysrhythmias. 00:52:29.800 --> 00:52:34.740 position:50% align:middle But now that I'm looking at the second menu, I bet they want me to say pulmonary embolism. 00:52:34.740 --> 00:52:39.520 position:50% align:middle So the point is, as you list your evidence, obviously, you need something to be the right answer, 00:52:39.520 --> 00:52:42.800 position:50% align:middle but you don't want everything to point to one place, right? 00:52:42.800 --> 00:52:46.750 position:50% align:middle You don't want to give hints or we call that cueing in the testing world. 00:52:46.750 --> 00:52:49.480 position:50% align:middle So let's do it. 00:52:49.480 --> 00:52:55.070 position:50% align:middle Whatever condition you thought they were at highest risk for, what's some evidence for that? 00:52:55.070 --> 00:53:00.580 position:50% align:middle What's some evidence from the case that made you believe they were at that highest risk? 00:53:00.580 --> 00:53:02.500 position:50% align:middle Okay, fever. 00:53:02.500 --> 00:53:03.852 position:50% align:middle Okay. 00:53:06.310 --> 00:53:07.370 position:50% align:middle All right, what else? 00:53:07.370 --> 00:53:13.640 position:50% align:middle Anything besides fever here, as I'm watching the chat. 00:53:13.640 --> 00:53:15.500 position:50% align:middle Okay, the respiratory rate. 00:53:15.500 --> 00:53:16.200 position:50% align:middle Excellent. 00:53:16.200 --> 00:53:22.610 position:50% align:middle And then the way we would fill out the rest of the menu then is with evidence that perhaps points 00:53:22.610 --> 00:53:26.540 position:50% align:middle to something else, right maybe one of the other things on the list. 00:53:26.540 --> 00:53:30.360 position:50% align:middle Okay, I'm seeing a lot of things come in, I think you get the idea. 00:53:30.360 --> 00:53:34.410 position:50% align:middle The item writer...and I'm happy to show this because I like what they've done here, 00:53:34.410 --> 00:53:40.810 position:50% align:middle the item writer has collapsed a whole bunch of the findings into these larger umbrella headings, vitals, 00:53:40.810 --> 00:53:43.760 position:50% align:middle neurologic, respiratory, cardiovascular. 00:53:43.760 --> 00:53:46.340 position:50% align:middle That's kind of a clever way to write the item. 00:53:46.340 --> 00:53:51.770 position:50% align:middle I would almost put that menu in my back pocket, right, and use that a lot, right? 00:53:51.770 --> 00:53:54.180 position:50% align:middle It's not about I don't have to pick out one little thing. 00:53:54.180 --> 00:53:58.690 position:50% align:middle But also sometimes when you think about it, there might have been many things related 00:53:58.690 --> 00:54:03.180 position:50% align:middle to respiration that support your highest risk, right? 00:54:03.180 --> 00:54:05.740 position:50% align:middle And so if you just list one of them, maybe that's not enough. 00:54:05.740 --> 00:54:09.456 position:50% align:middle Maybe it's important for students or our test takers to recognize, 00:54:09.456 --> 00:54:14.435 position:50% align:middle well, it wasn't just this one thing about respiratory, it was kind of all of them taken together. 00:54:14.435 --> 00:54:17.610 position:50% align:middle Okay, well done. 00:54:17.610 --> 00:54:21.810 position:50% align:middle We get to the fourth interactive item in the set. 00:54:21.810 --> 00:54:26.772 position:50% align:middle The nurse has reviewed the nurses' notes entries from 10 a.m. and noon we'll say 00:54:26.772 --> 00:54:28.468 position:50% align:middle and is planning care for the client. 00:54:28.468 --> 00:54:32.420 position:50% align:middle For each potential intervention, click to specify whether it's indicated or 00:54:32.420 --> 00:54:35.170 position:50% align:middle contraindicated for the care of the client. 00:54:35.530 --> 00:54:36.400 position:50% align:middle Perfect. 00:54:36.400 --> 00:54:43.020 position:50% align:middle Okay, so this is a little bit like the one we saw before, but I want to call your attention to the fact 00:54:43.020 --> 00:54:47.100 position:50% align:middle that new information has shown up on this tab and it's at noon. 00:54:47.100 --> 00:54:52.450 position:50% align:middle Noon, so two hours later called to bedside by the daughter who states her mother isn't acting right. 00:54:52.450 --> 00:54:56.510 position:50% align:middle Upon assessment client difficult to arouse, pale, diaphoretic in appearance. 00:54:56.510 --> 00:55:04.720 position:50% align:middle The vitals are a little different here, 101.5, pulse maybe a lot different 112, respiration 32, 00:55:04.720 --> 00:55:08.200 position:50% align:middle blood pressure has dropped a bit there, 90 over 62. 00:55:08.200 --> 00:55:12.820 position:50% align:middle Pulse ox down 91% on the same two liters. 00:55:12.820 --> 00:55:14.998 position:50% align:middle So, things have changed, right? 00:55:14.998 --> 00:55:16.025 position:50% align:middle We've got a before and after. 00:55:16.025 --> 00:55:18.420 position:50% align:middle We haven't really done our interventions yet. 00:55:18.420 --> 00:55:24.440 position:50% align:middle But it's time to think about what kind of interventions might help in this case. 00:55:24.440 --> 00:55:27.330 position:50% align:middle So let's write the item this way. 00:55:27.330 --> 00:55:31.765 position:50% align:middle Tell me some interventions that you think could help this person based on the new information 00:55:31.765 --> 00:55:36.310 position:50% align:middle we see at noon, but certainly factoring in what it looked like at 10.00? 00:55:36.310 --> 00:55:38.360 position:50% align:middle Okay, a sit-up position. 00:55:38.360 --> 00:55:39.780 position:50% align:middle Perfect, Christina. 00:55:39.780 --> 00:55:40.710 position:50% align:middle IV fluids. 00:55:40.710 --> 00:55:42.800 position:50% align:middle Okay, perfect, Valerie. 00:55:42.800 --> 00:55:44.400 position:50% align:middle Okay, fluids again. 00:55:44.400 --> 00:55:45.060 position:50% align:middle Good. 00:55:45.060 --> 00:55:46.900 position:50% align:middle Dr. Gina, increase oxygen. 00:55:46.900 --> 00:55:47.670 position:50% align:middle Love it. 00:55:47.670 --> 00:55:49.220 position:50% align:middle I think we're going to see that. 00:55:49.220 --> 00:55:52.010 position:50% align:middle Okay, antibiotics. 00:55:52.010 --> 00:55:54.630 position:50% align:middle I'm seeing increasing the head of the bed. 00:55:54.630 --> 00:55:55.715 position:50% align:middle Fabulous. 00:55:55.715 --> 00:56:00.710 position:50% align:middle Okay, this group is setting a record for the most suggestions. 00:56:00.710 --> 00:56:08.060 position:50% align:middle And as a non-nurse, I can't say all wonderful, but I suspect all nearly all wonderful. 00:56:08.060 --> 00:56:08.810 position:50% align:middle Great. 00:56:08.810 --> 00:56:13.310 position:50% align:middle Now, thinking like an item writer, let's have some distractors. 00:56:13.310 --> 00:56:19.010 position:50% align:middle So tell me some things that would be contraindicated for this particular client. 00:56:19.010 --> 00:56:22.200 position:50% align:middle We don't want to be too obvious, like I'm sure nobody would choose, 00:56:22.200 --> 00:56:24.710 position:50% align:middle discharge the patient immediately, right. 00:56:24.710 --> 00:56:27.460 position:50% align:middle That's probably a silly one we wouldn't include it. 00:56:27.460 --> 00:56:32.770 position:50% align:middle But what are some things that maybe some of your students who didn't pay attention during parts of the 00:56:32.770 --> 00:56:36.540 position:50% align:middle year might go with, right, but really, they're contraindicated? 00:56:36.540 --> 00:56:38.010 position:50% align:middle What are some things we wouldn't do? 00:56:38.010 --> 00:56:41.450 position:50% align:middle Pain meds, yeah. 00:56:41.450 --> 00:56:43.740 position:50% align:middle Prepare for chest tubes. 00:56:43.740 --> 00:56:44.350 position:50% align:middle Okay. 00:56:44.350 --> 00:56:49.210 position:50% align:middle Increase activity, okay, sit them up in a chair, ambulate, love it. 00:56:49.210 --> 00:56:50.250 position:50% align:middle Let's take a look. 00:56:50.250 --> 00:56:55.370 position:50% align:middle Survey says, okay, prepare for defibrillation, place client in a semi-Fowler's. 00:56:55.370 --> 00:56:57.340 position:50% align:middle I think I saw that from a few of you. 00:56:57.340 --> 00:57:00.270 position:50% align:middle Request an order to increase oxygen. 00:57:00.270 --> 00:57:02.690 position:50% align:middle The IV, yeah. 00:57:02.690 --> 00:57:07.680 position:50% align:middle Okay, and inserting peripheral VAD, right. 00:57:07.680 --> 00:57:12.673 position:50% align:middle So these are the choices, some are keys, some are distractors, right, but you get the idea. 00:57:12.673 --> 00:57:19.140 position:50% align:middle It's about thinking about what kinds of things would help, what kinds of things would not be appropriate. 00:57:19.140 --> 00:57:21.400 position:50% align:middle Let's go to this next one. 00:57:21.400 --> 00:57:22.460 position:50% align:middle Take action. 00:57:22.460 --> 00:57:24.683 position:50% align:middle The nurse has received orders from the physician. 00:57:24.683 --> 00:57:28.820 position:50% align:middle Cloick to highlight the three orders that the nurse should perform right away. 00:57:28.820 --> 00:57:33.630 position:50% align:middle So you get the idea the physician has listed five things, right? 00:57:33.630 --> 00:57:35.520 position:50% align:middle Well, we can't do them all at once, right? 00:57:35.520 --> 00:57:37.380 position:50% align:middle I don't even know if we can do three things at once. 00:57:37.380 --> 00:57:38.490 position:50% align:middle Is that possible? 00:57:38.490 --> 00:57:41.650 position:50% align:middle Well, nurses are capable of miracles, I suppose. 00:57:41.650 --> 00:57:44.520 position:50% align:middle So the way we're going to write this item is 00:57:44.520 --> 00:57:49.587 position:50% align:middle I need you to anticipate three orders that would have some urgency. 00:57:49.587 --> 00:57:55.609 position:50% align:middle What are three things that could come from the physician that we would want to do right away, ASAP? 00:57:56.010 --> 00:57:58.700 position:50% align:middle Okay, go ahead and use the chat. 00:57:58.700 --> 00:58:01.340 position:50% align:middle And I see questions coming in for me. 00:58:01.340 --> 00:58:04.600 position:50% align:middle I'll do my best at the end to jump in and try to grab those. 00:58:04.600 --> 00:58:08.520 position:50% align:middle Anything I don't get live today I'll do my best to answer by email if I can. 00:58:08.520 --> 00:58:09.150 position:50% align:middle Okay. 00:58:09.150 --> 00:58:12.510 position:50% align:middle More oxygen, chest X-ray, order labs. 00:58:12.510 --> 00:58:13.720 position:50% align:middle You're right. 00:58:13.720 --> 00:58:19.160 position:50% align:middle Oxygen, blood cultures, antibiotics, start the IV, sepsis workup, fluids. 00:58:19.160 --> 00:58:20.570 position:50% align:middle This group is awesome. 00:58:20.570 --> 00:58:21.560 position:50% align:middle Okay. 00:58:21.560 --> 00:58:28.519 position:50% align:middle Now, shifting gears, what are some orders we can anticipate that don't need to be done right away? 00:58:28.519 --> 00:58:33.840 position:50% align:middle Maybe it's you know, you could wait till tomorrow on this one, or, you know, come back later for this one. 00:58:33.840 --> 00:58:38.620 position:50% align:middle You could even list something that the nurse might be right to question, right? 00:58:38.620 --> 00:58:43.870 position:50% align:middle But the point is, we've got five things on the list, we can tell so we need to that aren't the right answer. 00:58:43.870 --> 00:58:49.860 position:50% align:middle Okay, I'm seeing echocardiogram, physical therapy, MRI, you get the idea. 00:58:49.860 --> 00:58:54.540 position:50% align:middle Okay, I think OT, occupational therapy, maybe? 00:58:54.540 --> 00:59:00.000 position:50% align:middle Okay, now, item writing trick, right, from Jason here. 00:59:00.000 --> 00:59:06.111 position:50% align:middle Pretend that you were trying to do this and you said, gosh, here are four things 00:59:06.111 --> 00:59:09.550 position:50% align:middle that need to be done right away and here are three things that don't. 00:59:09.550 --> 00:59:10.324 position:50% align:middle Well, that's okay. 00:59:10.324 --> 00:59:11.299 position:50% align:middle That's a good item too. 00:59:11.299 --> 00:59:15.086 position:50% align:middle You could list four things that need to be done right away and three things that don't. 00:59:15.086 --> 00:59:20.380 position:50% align:middle We would just change the intro and say click to highlight the four orders, right? 00:59:20.380 --> 00:59:21.380 position:50% align:middle So there's flexibility. 00:59:21.380 --> 00:59:25.160 position:50% align:middle Sometimes you'll see these numbers and you'll say, okay, let me try and match that. 00:59:25.160 --> 00:59:29.330 position:50% align:middle But sometimes you'll say, I've got a better idea they didn't think of and I want to use it. 00:59:29.330 --> 00:59:32.150 position:50% align:middle Well, that's okay, go ahead and change it, right. 00:59:32.150 --> 00:59:33.410 position:50% align:middle So nothing sacred here. 00:59:33.410 --> 00:59:35.140 position:50% align:middle These templates are like guides. 00:59:35.140 --> 00:59:38.430 position:50% align:middle Okay, what did the item writer do? 00:59:38.430 --> 00:59:47.940 position:50% align:middle Well, indwelling urinary catheter, some antibiotics, CT scan, some normal saline through IV and lab tests, 00:59:47.940 --> 00:59:52.900 position:50% align:middle right, those were the five and evidently, three of these have some urgency to them. 00:59:54.450 --> 00:59:56.640 position:50% align:middle Let's finish it off here. 00:59:56.640 --> 01:00:02.254 position:50% align:middle Okay, so we see those same orders now listed. 01:00:02.254 --> 01:00:05.652 position:50% align:middle they got a tab so the person doesn't have to remember what they were, right? 01:00:05.652 --> 01:00:07.060 position:50% align:middle They are there. 01:00:07.060 --> 01:00:10.710 position:50% align:middle And we can see now on the right-hand side, the item. 01:00:10.710 --> 01:00:14.251 position:50% align:middle The nurse has performed the interventions as ordered by the physician for the client. 01:00:14.251 --> 01:00:18.220 position:50% align:middle For each assessment finding, click to specify if the finding indicates that 01:00:18.220 --> 01:00:23.890 position:50% align:middle the client's condition has improved, has not changed, or has declined. 01:00:23.890 --> 01:00:28.290 position:50% align:middle So in these case studies, there's a notion of before and after, right? 01:00:28.290 --> 01:00:35.440 position:50% align:middle When you first made your visit, the client after some interventions, and obviously, 01:00:35.440 --> 01:00:39.540 position:50% align:middle you know, things have changed,maybe they got better, we hope, some might have got worse, 01:00:39.540 --> 01:00:41.050 position:50% align:middle some might have stayed the same. 01:00:41.050 --> 01:00:47.090 position:50% align:middle Okay, so I'm going to actually click now to the original nurses' notes, 01:00:47.090 --> 01:00:49.380 position:50% align:middle so we can see what some of the original things were. 01:00:49.380 --> 01:00:53.430 position:50% align:middle The way we would write this item when we're talking about evaluate outcomes is, 01:00:53.430 --> 01:00:58.350 position:50% align:middle we want to think about data after the interventions were performed. 01:00:58.350 --> 01:01:03.260 position:50% align:middle Now, if you look carefully, the nurses' notes here, even though there's 10:00 and noon, 01:01:03.260 --> 01:01:05.970 position:50% align:middle these were before the interventions, right? 01:01:05.970 --> 01:01:11.242 position:50% align:middle So in other words, when I'm writing this item an assessment finding now 01:01:11.242 --> 01:01:14.507 position:50% align:middle might be temperature of 103, right? 01:01:14.507 --> 01:01:19.240 position:50% align:middle The point is, I don't need to just copy and paste the stuff from 10:00 and 12:00. 01:01:19.240 --> 01:01:23.210 position:50% align:middle Pretend it's 2:00 or 3:00 now, what does the client look like now? 01:01:23.210 --> 01:01:24.871 position:50% align:middle Well, it's not on the left-hand side. 01:01:24.871 --> 01:01:27.985 position:50% align:middle We're just going to be describing it over here in this table. 01:01:27.985 --> 01:01:29.800 position:50% align:middle So let's see what you can do. 01:01:29.800 --> 01:01:36.545 position:50% align:middle Come up with something that the client might have at 2:00, 3:00, you name it, 01:01:36.545 --> 01:01:41.930 position:50% align:middle that would be interesting to evaluate as to whether it's better or worse, or the same. 01:01:41.930 --> 01:01:44.970 position:50% align:middle Okay, pulse ox 95%, pulse 88. 01:01:44.970 --> 01:01:49.080 position:50% align:middle Okay, these are two fantastic ones. 01:01:49.080 --> 01:01:51.490 position:50% align:middle JVD and crackles. 01:01:51.490 --> 01:01:57.600 position:50% align:middle Okay, I hope JVD doesn't stand for Jason Very Dull, but other than that, I like it. 01:01:57.600 --> 01:02:04.620 position:50% align:middle Blood pressure 120 over 85, respiration is 12, okay, increased temperature. 01:02:04.620 --> 01:02:05.970 position:50% align:middle Okay, fantastic. 01:02:05.970 --> 01:02:10.131 position:50% align:middle And it could be stated that way, or temperature could just be listed 01:02:10.131 --> 01:02:14.790 position:50% align:middle that happens to be higher than what there was before, right? 01:02:14.790 --> 01:02:16.970 position:50% align:middle Decreased work in breathing. 01:02:16.970 --> 01:02:18.980 position:50% align:middle Decreased temperature, sure. 01:02:18.980 --> 01:02:21.202 position:50% align:middle Okay. 01:02:21.202 --> 01:02:25.090 position:50% align:middle And maybe it depends how much it decreased, right, whether that's good or bad. 01:02:25.090 --> 01:02:29.641 position:50% align:middle But the shortness of breath...and we probably want to describe it in a way that 01:02:29.641 --> 01:02:33.460 position:50% align:middle somebody could decide whether, in fact, it's, you know, better or worse or the same. 01:02:33.460 --> 01:02:34.050 position:50% align:middle But excellent. 01:02:34.050 --> 01:02:36.370 position:50% align:middle This group is awesome. 01:02:36.370 --> 01:02:39.730 position:50% align:middle Survey says respiration of 36. 01:02:39.730 --> 01:02:41.959 position:50% align:middle I believe that is worse. 01:02:41.959 --> 01:02:46.224 position:50% align:middle Blood pressure 118 over 68. I believe that is better. 01:02:46.224 --> 01:02:48.390 position:50% align:middle Don't trust me, y'all. 01:02:48.390 --> 01:02:53.350 position:50% align:middle Pale skin tone, I feel like that's kind of the same-ish, but I may be missing some subtlety. 01:02:53.350 --> 01:02:55.620 position:50% align:middle Pulse ox 91. 01:02:55.620 --> 01:03:00.120 position:50% align:middle Well, that seems the same as noon so I guess that's stable. 01:03:00.120 --> 01:03:02.750 position:50% align:middle And then interacting with daughter at bedside. 01:03:02.750 --> 01:03:08.140 position:50% align:middle Now I'm going to be honest, I like your work better than this item writer for one reason. 01:03:08.140 --> 01:03:13.320 position:50% align:middle As a testing professional, it's very important to me that items are very precise 01:03:13.320 --> 01:03:14.910 position:50% align:middle so there's no ambiguity. 01:03:14.910 --> 01:03:20.900 position:50% align:middle As nurses, you may see interacting with daughter at bedside, and you may know that that implies 01:03:20.900 --> 01:03:23.900 position:50% align:middle positive healthy interactions. 01:03:23.900 --> 01:03:28.102 position:50% align:middle For me as a testing professional, the word interacting can go either way, right? 01:03:28.102 --> 01:03:32.180 position:50% align:middle The interacting could be argumentative, paranoid, right? 01:03:32.180 --> 01:03:35.540 position:50% align:middle So I would prefer something more specific. 01:03:35.540 --> 01:03:38.210 position:50% align:middle To me, the word interacting has some ambiguity. 01:03:38.210 --> 01:03:41.930 position:50% align:middle So I like your choices better but you get the idea. 01:03:41.930 --> 01:03:48.600 position:50% align:middle Well, congratulations, you have made it to the end of a case study. 01:03:48.600 --> 01:03:50.180 position:50% align:middle Why do I do that exercise? 01:03:50.180 --> 01:03:53.420 position:50% align:middle Because I want to demystify these NGN items. 01:03:53.420 --> 01:03:59.770 position:50% align:middle I want to demystify our Clinical Judgment Measurement Model, these boxes, right? 01:03:59.770 --> 01:04:04.550 position:50% align:middle So again, I have a full half-day training or a half full-day training, take your pick, 01:04:04.550 --> 01:04:08.880 position:50% align:middle called the Action Model, that's all about writing from a blank piece of paper, right. 01:04:08.880 --> 01:04:14.630 position:50% align:middle But one of the great ways to come up with ideas is to look at ones we already have, and put some twists, 01:04:14.630 --> 01:04:16.980 position:50% align:middle right, or come up with your own, okay. 01:04:16.980 --> 01:04:21.140 position:50% align:middle And you could imagine, you know, how could you really make some changes? 01:04:21.140 --> 01:04:25.990 position:50% align:middle Well, you could change some things in this scenario, right, and then ask the same questions or 01:04:25.990 --> 01:04:27.530 position:50% align:middle ask different questions. 01:04:27.530 --> 01:04:28.490 position:50% align:middle Okay. 01:04:28.490 --> 01:04:31.660 position:50% align:middle Well, I mentioned at the very beginning, we have two different ways 01:04:31.660 --> 01:04:33.090 position:50% align:middle to measure clinical judgment. 01:04:33.090 --> 01:04:37.680 position:50% align:middle One is through the case study, but, well, you saw, case studies are long, right? 01:04:37.680 --> 01:04:41.080 position:50% align:middle It's a lot to read, and then you have to answer six questions. 01:04:41.080 --> 01:04:47.340 position:50% align:middle We also have items, individual items, one item called standalone that measure clinical 01:04:47.340 --> 01:04:50.200 position:50% align:middle judgment all by themselves. 01:04:50.200 --> 01:04:55.070 position:50% align:middle And interestingly enough, they may target more than one of those boxes 01:04:55.070 --> 01:04:56.040 position:50% align:middle they usually do. 01:04:56.040 --> 01:05:00.276 position:50% align:middle I will illustrate that for you but we have a newsletter that goes into more detail. 01:05:02.780 --> 01:05:07.990 position:50% align:middle So let's see, we've got the sample trend item here. 01:05:07.990 --> 01:05:11.710 position:50% align:middle The trend is the first of our two. 01:05:11.710 --> 01:05:12.750 position:50% align:middle What is a trend item? 01:05:12.750 --> 01:05:17.600 position:50% align:middle I'm going to focus less on the content here because we're pretty contented out if that's a word. 01:05:17.600 --> 01:05:19.970 position:50% align:middle What is a trend item? 01:05:19.970 --> 01:05:24.740 position:50% align:middle We are presenting information at different points in time, right? 01:05:24.740 --> 01:05:29.950 position:50% align:middle I think of it as time-stamped data, in this case intake output and nurses' notes, right? 01:05:29.950 --> 01:05:32.560 position:50% align:middle And then we're simply asking a question about it. 01:05:32.560 --> 01:05:38.200 position:50% align:middle And as the name suggests, well, probably there's some trend that we should have noticed 01:05:38.200 --> 01:05:39.580 position:50% align:middle or paid attention to. 01:05:39.580 --> 01:05:45.520 position:50% align:middle So I mentioned that the standalone items, right, it kind of looks like a case study but there's 01:05:45.520 --> 01:05:46.690 position:50% align:middle only one question. 01:05:46.690 --> 01:05:51.020 position:50% align:middle These standalone items, nonetheless, can target multiple boxes out of those 01:05:51.020 --> 01:05:52.210 position:50% align:middle six-layered three boxes. 01:05:52.210 --> 01:05:52.920 position:50% align:middle Well, let's take a look. 01:05:52.920 --> 01:05:57.690 position:50% align:middle This one is asking which of the following procedures should the nurse anticipate? 01:05:57.690 --> 01:06:01.421 position:50% align:middle Well, that probably reminds you of the generate solutions or 01:06:01.421 --> 01:06:04.990 position:50% align:middle take action type stuff that we just saw, right? 01:06:04.990 --> 01:06:10.150 position:50% align:middle However, you can imagine, for someone to be successful with this item, 01:06:10.150 --> 01:06:17.450 position:50% align:middle they would have had to implicitly recognized cues, analyzed cues, they may have formulated hypotheses, 01:06:17.450 --> 01:06:21.160 position:50% align:middle or picked a particular condition that needs prioritization. 01:06:21.160 --> 01:06:28.360 position:50% align:middle So the point is, they may have done the first four steps in the Clinical Judgment Measurement Model 01:06:28.360 --> 01:06:32.958 position:50% align:middle to be able to answer what may here feel most like a take action. 01:06:33.130 --> 01:06:36.777 position:50% align:middle So that's what I mean by these things may address multiple boxes. 01:06:37.550 --> 01:06:40.060 position:50% align:middle Let me go into the bow-tie. 01:06:40.060 --> 01:06:45.440 position:50% align:middle This is the second of two ways we can measure clinical judgment with just a single item. 01:06:45.440 --> 01:06:46.870 position:50% align:middle So here we go. 01:06:46.870 --> 01:06:50.860 position:50% align:middle I won't delve into the content deeply at all, I'll just note. 01:06:50.860 --> 01:06:54.210 position:50% align:middle Again, we see a couple of tabs kind of like an exhibit item today. 01:06:54.210 --> 01:06:57.824 position:50% align:middle On the right-hand side, we have something a little unusual you haven't seen yet. 01:06:57.824 --> 01:07:02.990 position:50% align:middle We call it a bow-tie item because the place you put your answers is shaped like a bowtie. 01:07:02.990 --> 01:07:09.214 position:50% align:middle I know hardly anybody wears those anymore, but I think Urkel and Young Sheldon might be 01:07:09.214 --> 01:07:12.370 position:50% align:middle the last holdouts on bowtie. 01:07:12.370 --> 01:07:18.400 position:50% align:middle But at any rate, you can see kind of a little X shape, we call it a bow-tie. 01:07:18.400 --> 01:07:22.300 position:50% align:middle Anyways, it's a drag and drop, but there's some special structure, 01:07:22.300 --> 01:07:23.290 position:50% align:middle the bow-tie structure. 01:07:23.290 --> 01:07:24.290 position:50% align:middle What does it mean? 01:07:24.290 --> 01:07:29.409 position:50% align:middle Well, it means in the middle of the bowtie where the knot would be, condition most likely experiencing, 01:07:29.409 --> 01:07:33.315 position:50% align:middle well, only the things from the middle list can go there. 01:07:33.315 --> 01:07:38.010 position:50% align:middle Actions to take. Only the things on the left can go there. 01:07:38.010 --> 01:07:42.380 position:50% align:middle Parameters to monitor. Only the things on the right can go there. 01:07:42.380 --> 01:07:46.450 position:50% align:middle The computer won't let you put Bell's palsy into action to take. 01:07:46.450 --> 01:07:48.301 position:50% align:middle The computer guards against these things. 01:07:48.301 --> 01:07:53.210 position:50% align:middle So there's some structure, but the computer kind of helps in case anybody gets confused. 01:07:53.210 --> 01:07:54.950 position:50% align:middle I think you get the idea. 01:07:54.950 --> 01:08:00.150 position:50% align:middle I mentioned checking off more than one box at layer three. 01:08:00.150 --> 01:08:03.386 position:50% align:middle Well action to take, that sure sounds like take action. 01:08:03.386 --> 01:08:08.736 position:50% align:middle Condition most likely experiencing, that probably sounds like prioritize hypotheses. 01:08:08.736 --> 01:08:13.480 position:50% align:middle Parameter to monitor. That has a little bit of an evaluation field. 01:08:13.480 --> 01:08:19.263 position:50% align:middle And again, to be successful, the candidate would have had to recognize cues 01:08:19.263 --> 01:08:20.490 position:50% align:middle and think about what they mean. 01:08:20.490 --> 01:08:23.100 position:50% align:middle In other words, analyze cues, right? 01:08:23.100 --> 01:08:26.730 position:50% align:middle In considering actions to take, they might have thought about more things 01:08:26.730 --> 01:08:28.200 position:50% align:middle before narrowing it down, right? 01:08:28.200 --> 01:08:30.070 position:50% align:middle So maybe some generate solutions. 01:08:30.070 --> 01:08:34.270 position:50% align:middle Some of my colleagues will say that our bow-tie items check off all six boxes. 01:08:34.270 --> 01:08:36.740 position:50% align:middle Sometimes I look at them and I decide five. 01:08:36.740 --> 01:08:39.740 position:50% align:middle But the point is multiple, right? 01:08:39.740 --> 01:08:40.857 position:50% align:middle There you go. 01:08:42.070 --> 01:08:47.965 position:50% align:middle Well, we have looked at almost all the content we're going to look at, and we're going to shift gears. 01:08:47.965 --> 01:08:50.740 position:50% align:middle We're going to go into test design. 01:08:50.740 --> 01:08:55.240 position:50% align:middle Test design is essentially the architecture of the next generation NCLEX. 01:08:55.240 --> 01:08:56.520 position:50% align:middle How many questions? 01:08:56.520 --> 01:08:57.720 position:50% align:middle How many hours? 01:08:57.720 --> 01:08:59.520 position:50% align:middle How many case studies? 01:08:59.520 --> 01:09:00.420 position:50% align:middle Bow-tie, trend? 01:09:00.420 --> 01:09:02.870 position:50% align:middle Is there some number of those we should expect? 01:09:02.870 --> 01:09:06.531 position:50% align:middle Some of you know we use Computer Adaptive Testing, we call it CAT. 01:09:06.531 --> 01:09:08.150 position:50% align:middle Is that still in the mix? 01:09:08.150 --> 01:09:09.190 position:50% align:middle Etc. 01:09:09.190 --> 01:09:11.960 position:50% align:middle And these are the questions I've been asked for years. 01:09:11.960 --> 01:09:17.270 position:50% align:middle And luckily, it was really in the last 12 months, that we finally analyzed enough data to be able 01:09:17.270 --> 01:09:20.600 position:50% align:middle to decide on the answers to all these questions. 01:09:20.600 --> 01:09:24.470 position:50% align:middle So good news for you, is I'm going to answer pretty much everything here. 01:09:24.470 --> 01:09:28.651 position:50% align:middle However, the big question is one you don't see here. 01:09:28.651 --> 01:09:31.490 position:50% align:middle This is really the big question everybody wanted to know. 01:09:31.490 --> 01:09:33.620 position:50% align:middle And I bet even for all of you, you want to know. 01:09:33.620 --> 01:09:35.045 position:50% align:middle Here it is. 01:09:35.045 --> 01:09:36.280 position:50% align:middle Okay, come on. 01:09:36.280 --> 01:09:39.783 position:50% align:middle How different is the NGN from the NCLEX? 01:09:39.783 --> 01:09:42.230 position:50% align:middle You've certainly seen some things that are different. 01:09:42.230 --> 01:09:44.400 position:50% align:middle The question is, is that the whole exam? 01:09:44.400 --> 01:09:49.920 position:50% align:middle The whole exam is case studies, bow-tie, standalone, oh my God, this is going to be a crazy test right? 01:09:49.920 --> 01:09:55.590 position:50% align:middle Or is it mostly the old exam, but with a few things we added a little bit? 01:09:55.590 --> 01:09:56.810 position:50% align:middle Well, let's see. 01:09:56.810 --> 01:10:03.070 position:50% align:middle So I will encourage you to picture today's NCLEX as a cheese pizza. 01:10:03.070 --> 01:10:05.320 position:50% align:middle So we know it's not really a cheese pizza. 01:10:05.320 --> 01:10:10.250 position:50% align:middle If it were, your students would like it better, and they would finish faster. 01:10:10.250 --> 01:10:13.160 position:50% align:middle Okay, but the point is, it's a cheese pizza. 01:10:13.160 --> 01:10:15.520 position:50% align:middle Now, next-generation NCLEX, is it a hamburger? 01:10:15.520 --> 01:10:16.070 position:50% align:middle Is it spaghetti? 01:10:16.070 --> 01:10:18.290 position:50% align:middle Is it a Caesar salad? 01:10:18.290 --> 01:10:19.970 position:50% align:middle Or is it this? 01:10:19.970 --> 01:10:21.180 position:50% align:middle Here it is. 01:10:21.180 --> 01:10:25.270 position:50% align:middle Next-generation NCLEX is that cheese pizza with some toppings. 01:10:25.270 --> 01:10:31.257 position:50% align:middle Here's what I want you to know, the overwhelming majority of questions your graduates will see 01:10:31.257 --> 01:10:37.370 position:50% align:middle are exactly like what they would see on the NCLEX today, okay. 01:10:37.370 --> 01:10:42.180 position:50% align:middle The vast majority of the test is staying the same, right? 01:10:42.180 --> 01:10:46.240 position:50% align:middle Just like this pizza on the right, you can call it a pepperoni pizza, 01:10:46.240 --> 01:10:50.440 position:50% align:middle I'm going to call it a cheese pizza but with a few pepperoni on it, right? 01:10:50.440 --> 01:10:51.990 position:50% align:middle That's the NGN. 01:10:51.990 --> 01:10:56.540 position:50% align:middle So let's now quantify some of this. 01:10:56.540 --> 01:10:59.440 position:50% align:middle Okay, we call this the approved test design. 01:10:59.440 --> 01:11:03.860 position:50% align:middle The most recent NGN newsletter is all about the test design. 01:11:03.860 --> 01:11:08.210 position:50% align:middle It is our most dense but informative newsletter. 01:11:08.210 --> 01:11:12.990 position:50% align:middle It goes into great detail, which I am just summarizing here. 01:11:12.990 --> 01:11:15.260 position:50% align:middle So time, staying the same. 01:11:15.260 --> 01:11:19.429 position:50% align:middle Let me emphasize by the way, some of you have RN students, some of you have PN students. 01:11:19.429 --> 01:11:25.740 position:50% align:middle Everything you're seeing right now applies to RN, and PN, no difference. 01:11:25.740 --> 01:11:28.490 position:50% align:middle I'm not going to show you a second chart, okay. 01:11:28.490 --> 01:11:30.340 position:50% align:middle So the time stays the same. 01:11:30.340 --> 01:11:33.890 position:50% align:middle Delivery, we're still using Computer Adaptive Testing. 01:11:33.890 --> 01:11:39.830 position:50% align:middle We say variable length because you probably know some of your graduates get a really short exam. 01:11:39.830 --> 01:11:42.660 position:50% align:middle They say, "Oh, gosh, this is scary I finished after 75 questions. 01:11:42.660 --> 01:11:44.500 position:50% align:middle Does that mean I failed?" 01:11:44.500 --> 01:11:46.290 position:50% align:middle Well, you know, actually, it doesn't. 01:11:46.290 --> 01:11:47.110 position:50% align:middle But okay. 01:11:47.110 --> 01:11:51.341 position:50% align:middle And some of them are like, "Oh, God, I hated the exam, I got 145 questions. 01:11:51.341 --> 01:11:52.844 position:50% align:middle I must have done really horrible." 01:11:52.844 --> 01:11:54.090 position:50% align:middle Well, no, not necessarily. 01:11:54.090 --> 01:11:55.300 position:50% align:middle It doesn't mean that, right? 01:11:55.300 --> 01:12:00.550 position:50% align:middle But it does have to do with how long it took the computer to figure out whether you passed or failed. 01:12:00.550 --> 01:12:05.802 position:50% align:middle But point is variable length cap, different test takers can get different numbers of items 01:12:05.802 --> 01:12:11.500 position:50% align:middle but of course, there's a range, 75 to 145 today, how about the NGN? 01:12:11.500 --> 01:12:13.330 position:50% align:middle A little more, right? 01:12:13.330 --> 01:12:17.600 position:50% align:middle We care mostly about the top end because that's where you start to worry about running out of time. 01:12:17.600 --> 01:12:23.880 position:50% align:middle On the top end, it goes up literally like, you know, two-ish percent 145 to 150. 01:12:23.880 --> 01:12:27.540 position:50% align:middle So not a big change there. 01:12:27.540 --> 01:12:31.910 position:50% align:middle You may know, today on the NCLEX, some of the items do not count. 01:12:31.910 --> 01:12:36.260 position:50% align:middle Some of the items do not contribute toward the pass-fail result. 01:12:36.260 --> 01:12:38.180 position:50% align:middle And we call these Pre-test items. 01:12:38.180 --> 01:12:45.480 position:50% align:middle We use them simply to collect data so we can decide if an item we just came up with, 01:12:45.480 --> 01:12:50.890 position:50% align:middle right, and put through our review committees, will be good to use in the future, right? 01:12:50.890 --> 01:12:52.990 position:50% align:middle We need data to make these decisions. 01:12:52.990 --> 01:12:56.570 position:50% align:middle Everything we do on the exam is based on data. 01:12:56.570 --> 01:12:58.200 position:50% align:middle Yes, I know that well. 01:12:58.200 --> 01:12:58.820 position:50% align:middle Okay. 01:12:58.820 --> 01:13:05.480 position:50% align:middle So what that means is takeaway these 15 that don't count, and we get the number of scored items, 01:13:05.480 --> 01:13:07.250 position:50% align:middle the number of items that count. 01:13:07.250 --> 01:13:09.670 position:50% align:middle Well, the candidates can't tell the difference. 01:13:09.670 --> 01:13:14.220 position:50% align:middle But the point is 15 don't count, here comes my math degree being put to work. 01:13:14.220 --> 01:13:17.330 position:50% align:middle I will now subtract 15 from the total items. 01:13:17.330 --> 01:13:23.850 position:50% align:middle And we see today's NCLEX 60 to 130 of the items count, NGN 70 to 135. 01:13:23.850 --> 01:13:27.070 position:50% align:middle So again, a little more, but not much. 01:13:27.070 --> 01:13:30.380 position:50% align:middle Now, let's break down those numbers. 01:13:30.380 --> 01:13:32.850 position:50% align:middle Case studies, how many will there be? 01:13:32.850 --> 01:13:34.480 position:50% align:middle Three that count. 01:13:34.480 --> 01:13:35.780 position:50% align:middle Three that count. 01:13:35.780 --> 01:13:42.410 position:50% align:middle I am giving it to you true for all candidates, all candidates will get three case studies that count, 01:13:42.410 --> 01:13:43.710 position:50% align:middle take it to Vegas. 01:13:43.710 --> 01:13:44.970 position:50% align:middle Okay. 01:13:44.970 --> 01:13:48.660 position:50% align:middle And each case study had six items, again, showing off the math. 01:13:48.660 --> 01:13:52.880 position:50% align:middle So that means 18 items are coming from case studies. 01:13:52.880 --> 01:13:58.130 position:50% align:middle Here comes some subtraction then, all right, on the NGN what's left? 01:13:58.130 --> 01:14:04.930 position:50% align:middle Well, if we take away the 18 that are in case studies we're left with somewhere between 52 and 117. 01:14:04.930 --> 01:14:08.970 position:50% align:middle I wish the numbers were a little more round or something but you get the idea. 01:14:08.970 --> 01:14:12.400 position:50% align:middle It is what it is, take away three case studies. 01:14:12.400 --> 01:14:19.780 position:50% align:middle Now a difference between today's NCLEX and the NGN is the composition of those items. 01:14:19.780 --> 01:14:25.750 position:50% align:middle Today's NCLEX you know what they are multiple-choice, select all that apply, exhibit item, 01:14:25.750 --> 01:14:27.690 position:50% align:middle the usual suspects. 01:14:27.690 --> 01:14:33.960 position:50% align:middle NGN, well, you saw bow-tie, you saw trend, but I also told you a whole bunch of these. 01:14:33.960 --> 01:14:41.010 position:50% align:middle Most of these are just normal NCLEX items that you know and maybe love today, but certainly know. 01:14:41.010 --> 01:14:48.784 position:50% align:middle Ballpark, I think what you'll read in the NGN newsletter is that roughly 10% of this number 01:14:48.784 --> 01:14:54.530 position:50% align:middle are kind of like that bow-tie trend, you know, NGN special type stuff, 01:14:54.530 --> 01:15:00.180 position:50% align:middle whereas about 90-ish percent of the number is going to be more like today's NCLEX. 01:15:00.180 --> 01:15:01.740 position:50% align:middle So there you go. 01:15:01.740 --> 01:15:03.750 position:50% align:middle We mentioned the 15 that don't count. 01:15:03.750 --> 01:15:06.380 position:50% align:middle But I want to say a special word about those. 01:15:06.380 --> 01:15:11.180 position:50% align:middle Today the 15 items that don't count look just like the rest of the test. 01:15:11.180 --> 01:15:12.240 position:50% align:middle Makes sense. 01:15:12.240 --> 01:15:17.050 position:50% align:middle Well, for NGN, there's a twist, right? 01:15:17.050 --> 01:15:20.410 position:50% align:middle For NGN, they're going to look just like the rest of NGN. 01:15:20.410 --> 01:15:21.010 position:50% align:middle What does that mean? 01:15:21.010 --> 01:15:24.600 position:50% align:middle It means in the 15 items that don't count, there could be a trend item, 01:15:24.600 --> 01:15:27.930 position:50% align:middle there could be a couple of bow-tie items, maybe, right? 01:15:27.930 --> 01:15:29.290 position:50% align:middle There could even be a case study. 01:15:29.290 --> 01:15:34.970 position:50% align:middle And if you really think about it, there could even be two case studies and 15 items, 01:15:34.970 --> 01:15:37.310 position:50% align:middle right because it's six items per. 01:15:37.310 --> 01:15:38.000 position:50% align:middle Wow. 01:15:38.000 --> 01:15:39.440 position:50% align:middle Okay. 01:15:39.440 --> 01:15:48.060 position:50% align:middle So, you may have a graduate come back and say, hey, you told me three case studies, I got four, right? 01:15:48.060 --> 01:15:53.440 position:50% align:middle We know students, graduates love to, you know, point these things out. 01:15:53.440 --> 01:15:56.180 position:50% align:middle And so their test wasn't broken, right. 01:15:56.180 --> 01:16:00.990 position:50% align:middle The point is if somebody did come back and say, I got four case studies, you know three of them counted 01:16:00.990 --> 01:16:01.910 position:50% align:middle one of them didn't. 01:16:01.910 --> 01:16:03.090 position:50% align:middle Could they tell them apart? 01:16:03.090 --> 01:16:04.220 position:50% align:middle Well, I hope not. 01:16:04.220 --> 01:16:05.540 position:50% align:middle But probably not, right. 01:16:05.540 --> 01:16:05.770 position:50% align:middle Okay. 01:16:05.770 --> 01:16:09.130 position:50% align:middle Anyways, that is the test design. 01:16:09.130 --> 01:16:18.618 position:50% align:middle Okay, we are closing in on the final pieces here of the presentation before we get to resources and Q&A. 01:16:18.618 --> 01:16:24.520 position:50% align:middle I'm seeing so many questions come in that I'm going to maybe go a little faster than normal for scoring, 01:16:24.520 --> 01:16:26.440 position:50% align:middle to try to conserve some time. 01:16:26.440 --> 01:16:28.080 position:50% align:middle Let's see if I could do that. 01:16:28.080 --> 01:16:31.210 position:50% align:middle So NCLEX today, any question? 01:16:31.210 --> 01:16:34.040 position:50% align:middle It's either right or wrong, period, that's it. 01:16:34.040 --> 01:16:36.250 position:50% align:middle No partial credit, right. 01:16:36.250 --> 01:16:41.350 position:50% align:middle But it was a select all that apply, and four of them were the right answer. 01:16:41.350 --> 01:16:44.110 position:50% align:middle And I got three of them how could I get a zero, right? 01:16:44.110 --> 01:16:44.960 position:50% align:middle We know, right? 01:16:44.960 --> 01:16:46.210 position:50% align:middle We know. 01:16:46.210 --> 01:16:48.350 position:50% align:middle Well, that's all changing, believe it or not, right? 01:16:48.350 --> 01:16:53.920 position:50% align:middle When we get to the NGN, right, any of these sort of complicated item types, 01:16:53.920 --> 01:16:58.850 position:50% align:middle even today's ordinary select all that apply, are moving to partial credit scoring. 01:16:58.850 --> 01:17:01.750 position:50% align:middle It's a more complicated model, but it provides better information. 01:17:01.750 --> 01:17:02.900 position:50% align:middle I'm going to show you that. 01:17:02.900 --> 01:17:03.830 position:50% align:middle So what does that mean? 01:17:03.830 --> 01:17:08.840 position:50% align:middle You will have, like some of the items I showed you in the case study or some that you helped write, 01:17:08.840 --> 01:17:12.610 position:50% align:middle maybe the item is worth 4 points, and somebody could get a 4, 01:17:12.610 --> 01:17:14.800 position:50% align:middle but they could even get a 3, or a 2, or a 1. 01:17:14.800 --> 01:17:17.710 position:50% align:middle And of course, they could still get a zero. 01:17:17.710 --> 01:17:22.787 position:50% align:middle Again, I hate to be complicated, but we have three different ways that we assign 01:17:22.787 --> 01:17:25.090 position:50% align:middle partial credit on the NGN. 01:17:25.090 --> 01:17:28.218 position:50% align:middle You don't need to be a scoring expert, I promise. 01:17:28.218 --> 01:17:30.710 position:50% align:middle We're not going to send the exam to you to score for us. 01:17:30.710 --> 01:17:32.590 position:50% align:middle You don't need to be a scoring expert. 01:17:32.590 --> 01:17:35.170 position:50% align:middle I want to acquaint you with how we're scoring. 01:17:35.170 --> 01:17:39.478 position:50% align:middle But believe me, I'd much rather you have an appreciation for the clinical judgment 01:17:39.478 --> 01:17:41.741 position:50% align:middle and how we test it than how we score it. 01:17:41.741 --> 01:17:43.890 position:50% align:middle Nonetheless, here we go. 01:17:43.890 --> 01:17:48.998 position:50% align:middle I choose geography examples here just so we don't have to think very hard at all about 01:17:48.998 --> 01:17:50.490 position:50% align:middle what the right answers are. 01:17:50.490 --> 01:17:52.750 position:50% align:middle Sometimes in nursing, you might look at something and say, oh, 01:17:52.750 --> 01:17:54.070 position:50% align:middle that could be corrective. 01:17:54.070 --> 01:17:55.210 position:50% align:middle Well, I don't want to go there. 01:17:55.210 --> 01:17:58.670 position:50% align:middle Okay, so partial credit, we can assign it three different ways. 01:17:58.670 --> 01:18:00.998 position:50% align:middle The first method is called +/-. 01:18:00.998 --> 01:18:05.570 position:50% align:middle And as the name suggests, you can get points for doing things right, 01:18:05.570 --> 01:18:08.440 position:50% align:middle you can lose points for doing things wrong. 01:18:08.440 --> 01:18:13.550 position:50% align:middle Let's take a look, pretend a candidate what countries are in North America goes with this? 01:18:13.550 --> 01:18:14.840 position:50% align:middle France, Mexico, Canada. 01:18:14.840 --> 01:18:18.900 position:50% align:middle Well, obviously, France is wrong, Mexico and Canada are right. 01:18:18.900 --> 01:18:25.110 position:50% align:middle Well, +/- scoring let's give a point for the right answers let's take away a point for the wrong answer. 01:18:25.110 --> 01:18:29.220 position:50% align:middle And we would get a final score then of 2 minus 1, 1 point total. 01:18:29.220 --> 01:18:35.050 position:50% align:middle Well, the best possible student out there hopefully, a lot of them, by the way, could have just put Mexico, 01:18:35.050 --> 01:18:39.030 position:50% align:middle Canada, United States, they would have got 3 minus 0, they would have got 3 out of 3. 01:18:39.030 --> 01:18:41.260 position:50% align:middle So a maximum of three points are possible. 01:18:41.260 --> 01:18:45.680 position:50% align:middle The response indicated, despite having two right answers, gets one point. 01:18:45.680 --> 01:18:45.940 position:50% align:middle Why? 01:18:45.940 --> 01:18:47.680 position:50% align:middle Because there's a penalty. 01:18:47.680 --> 01:18:49.840 position:50% align:middle Why do we build in that penalty? 01:18:49.840 --> 01:18:51.930 position:50% align:middle Here's the answer. 01:18:51.930 --> 01:18:57.980 position:50% align:middle If there were no penalty, why wouldn't you just click every box, right? 01:18:57.980 --> 01:19:01.970 position:50% align:middle If there were no penalty, and you came to a select all that apply, 01:19:01.970 --> 01:19:07.480 position:50% align:middle just check all the boxes, you've covered all the keys, and there's no penalty for the stuff that's wrong, 01:19:07.480 --> 01:19:12.500 position:50% align:middle right, you've just ruined our test, you've ruined our item type. 01:19:12.500 --> 01:19:18.350 position:50% align:middle So the point is, we have to build in penalty to prevent someone from sort of gaming the system and just 01:19:18.350 --> 01:19:20.950 position:50% align:middle checking off all the boxes. 01:19:20.950 --> 01:19:22.760 position:50% align:middle So that's why. 01:19:22.760 --> 01:19:28.580 position:50% align:middle A quick little footnote here which will be on the quiz is that theoretically, 01:19:28.580 --> 01:19:31.870 position:50% align:middle you could imagine an overall negative score. 01:19:31.870 --> 01:19:36.800 position:50% align:middle For example, pretend the candidate only checked off France. 01:19:36.800 --> 01:19:45.250 position:50% align:middle Well, if they only checked off France, they didn't do anything right and they got one wrong. 01:19:45.250 --> 01:19:47.780 position:50% align:middle So that would be 0 minus 1 equals -1. 01:19:47.780 --> 01:19:52.712 position:50% align:middle However...pardon me I'm losing my voice a little bit. 01:19:52.712 --> 01:19:55.110 position:50% align:middle However, we are kind here. 01:19:55.110 --> 01:19:56.300 position:50% align:middle We always round up to zero. 01:19:56.300 --> 01:19:57.687 position:50% align:middle We do not assign negatives. 01:19:57.687 --> 01:20:02.890 position:50% align:middle So somebody, the formula gives them a negative, we will give them a zero. 01:20:02.890 --> 01:20:05.240 position:50% align:middle Okay, that will be on the quiz I think. 01:20:05.240 --> 01:20:11.914 position:50% align:middle All right, let's now look at an item that's almost identical but we score it a different way. 01:20:11.914 --> 01:20:13.400 position:50% align:middle Here we go. 01:20:13.400 --> 01:20:16.100 position:50% align:middle And you saw one of these, I think, in our case, you know. 01:20:16.100 --> 01:20:21.190 position:50% align:middle I think we had a which four, or which three or something in one of our samples. 01:20:21.190 --> 01:20:24.510 position:50% align:middle But anyways, which three of these countries are in North America? 01:20:24.510 --> 01:20:30.670 position:50% align:middle And now here we go, the computer will not let you check every box, the computer will not let you check more 01:20:30.670 --> 01:20:32.510 position:50% align:middle than three boxes. 01:20:32.510 --> 01:20:39.860 position:50% align:middle Well, therefore, since you can't do that, we don't need to penalize. 01:20:39.860 --> 01:20:44.420 position:50% align:middle Let's pretend we get the same response France, Mexico, Canada, we can simply say, hey, 01:20:44.420 --> 01:20:47.150 position:50% align:middle good job on Mexico and Canada. 01:20:47.150 --> 01:20:52.750 position:50% align:middle France, no, not yet I wouldn't mind if that vacation were a little cheaper but we're going 01:20:52.750 --> 01:20:53.860 position:50% align:middle to call that wrong. 01:20:53.860 --> 01:20:56.890 position:50% align:middle But it's just two points. There's no penalty. 01:20:56.890 --> 01:21:01.020 position:50% align:middle So what was the difference, because these two questions look almost the same? 01:21:01.020 --> 01:21:06.210 position:50% align:middle Well, the penalty is needed to prevent gaming the system, checking all the boxes. 01:21:06.210 --> 01:21:12.750 position:50% align:middle But if the computer doesn't let you check off all the boxes, then I don't need to build in the penalty. 01:21:12.750 --> 01:21:18.690 position:50% align:middle So we call this 0/1 scoring because for each of the responses, you either get a zero or a one, 01:21:18.690 --> 01:21:24.790 position:50% align:middle whereas in the previous example, you either got one point or -1 points. 01:21:24.790 --> 01:21:30.623 position:50% align:middle Third and final approach is the one used the least, but I'll share it nonetheless. 01:21:30.623 --> 01:21:33.610 position:50% align:middle It is called Rationale Scoring. 01:21:33.610 --> 01:21:39.240 position:50% align:middle And the way rationale scoring works is if you look at this question, it's kind of connecting countries 01:21:39.240 --> 01:21:41.160 position:50% align:middle to their capitals. 01:21:41.160 --> 01:21:45.340 position:50% align:middle You see four places where a response, drag, and drop response needs to go. 01:21:45.340 --> 01:21:49.560 position:50% align:middle You see four things, we don't have to score it as four points because maybe 01:21:49.560 --> 01:21:55.750 position:50% align:middle we care less about a country or a city, we care more about a relationship. 01:21:55.750 --> 01:22:01.170 position:50% align:middle Example, capital of France is Paris, rather than say, great job, two points, 01:22:05.134 --> 01:22:05.134 position:50% align:middle we're going to say you know what the whole point of this item is the relationship 01:22:05.134 --> 01:22:09.540 position:50% align:middle and you got this relationship right, therefore, you got a point. 01:22:09.540 --> 01:22:15.140 position:50% align:middle In rationale scoring, we are combining multiple response elements into a 01:22:15.140 --> 01:22:16.970 position:50% align:middle single scorable unit. 01:22:16.970 --> 01:22:19.370 position:50% align:middle I know that's some testing jargon for you. 01:22:19.370 --> 01:22:21.790 position:50% align:middle Let me illustrate with this next example. 01:22:21.790 --> 01:22:29.070 position:50% align:middle Capital of Egypt is well, of course, it's not Japan, but you can imagine if we scored each box by itself, 01:22:29.070 --> 01:22:31.970 position:50% align:middle I wouldn't really know what to do with an answer of Egypt. 01:22:31.970 --> 01:22:37.350 position:50% align:middle It's not really wrong by itself, right, but I don't really know what to think, right? 01:22:37.350 --> 01:22:42.510 position:50% align:middle But obviously, the statement, the capital of Egypt is Japan is clearly incorrect. 01:22:42.510 --> 01:22:48.430 position:50% align:middle So it's just a decision that we made to say, hey, we're going to group some of these units together 01:22:48.430 --> 01:22:49.910 position:50% align:middle for scoring purposes. 01:22:49.910 --> 01:22:55.700 position:50% align:middle So in this case, we would choose to give one point for the first sentence, no points for the second sentence. 01:22:55.700 --> 01:23:00.430 position:50% align:middle What does this look like in nursing or on the NGN? 01:23:00.430 --> 01:23:03.070 position:50% align:middle You might see something like...I think we saw an example of this. 01:23:03.070 --> 01:23:05.960 position:50% align:middle I think we saw a pull-down menu just this way. 01:23:05.960 --> 01:23:10.910 position:50% align:middle The client is at highest risk of x, because of y, right? 01:23:10.910 --> 01:23:12.910 position:50% align:middle So what do we care about here? 01:23:12.910 --> 01:23:15.190 position:50% align:middle Well, we care what they're at the highest risk of. 01:23:15.190 --> 01:23:24.520 position:50% align:middle But the point of this question is the relationship, the rationale, connecting evidence to outcome, right? 01:23:24.520 --> 01:23:29.370 position:50% align:middle Other example the nurse should question the order for x because of y. 01:23:29.370 --> 01:23:30.935 position:50% align:middle We care about the reasoning here. 01:23:30.935 --> 01:23:33.691 position:50% align:middle Did you choose the right thing for the right reason? 01:23:33.691 --> 01:23:37.540 position:50% align:middle If so, great job, you're scoring a point. 01:23:37.540 --> 01:23:42.970 position:50% align:middle If you chose the right thing and gave us the wrong reason, that might start to look more like you just 01:23:42.970 --> 01:23:49.751 position:50% align:middle random guessed, or that there's a misconception perhaps significant enough as to almost 01:23:49.751 --> 01:23:51.410 position:50% align:middle outweigh what you did well. 01:23:51.410 --> 01:23:58.630 position:50% align:middle Point is, sometimes it makes sense if the response options are connected to each other, 01:23:58.630 --> 01:24:03.550 position:50% align:middle to go ahead and connect them for scoring purposes. 01:24:03.550 --> 01:24:06.560 position:50% align:middle Benefits of partial credit scoring. 01:24:06.560 --> 01:24:09.220 position:50% align:middle Measurement precision, this is really what it's about. 01:24:09.220 --> 01:24:10.230 position:50% align:middle I'll illustrate this. 01:24:10.230 --> 01:24:16.290 position:50% align:middle Pretend that all of your students ever are lined up from least knowledge and ability to most 01:24:16.290 --> 01:24:17.600 position:50% align:middle knowledge and ability. 01:24:17.600 --> 01:24:22.860 position:50% align:middle Anytime I ask a question that scored 0/1, all right or all wrong, 01:24:22.860 --> 01:24:27.340 position:50% align:middle it divides those students or my test-takers into two groups. 01:24:27.340 --> 01:24:29.030 position:50% align:middle These groups can be very large. 01:24:29.030 --> 01:24:34.960 position:50% align:middle And as you know, the group that got it right may include somebody who just barely knew enough, 01:24:34.960 --> 01:24:36.940 position:50% align:middle and somebody who knew everything, right? 01:24:36.940 --> 01:24:39.530 position:50% align:middle So these two groups have a lot of variance. 01:24:39.530 --> 01:24:41.950 position:50% align:middle These two groups are very heterogeneous, right? 01:24:41.950 --> 01:24:45.100 position:50% align:middle The candidates in each group might be very different from each other. 01:24:45.100 --> 01:24:49.183 position:50% align:middle Well, ultimately, what we're trying to do with the NCLEX next generation or not right, 01:24:49.183 --> 01:24:55.540 position:50% align:middle is get as precise a measure as possible of the candidates' ability, right? 01:24:55.540 --> 01:25:00.770 position:50% align:middle And so if we use partial credit scoring, we've now taken the same lineup, 01:25:00.770 --> 01:25:07.470 position:50% align:middle and with a single item, with a single item, but partial credit scoring, we've now made five groups. 01:25:07.470 --> 01:25:09.950 position:50% align:middle Each one is pretty small. 01:25:09.950 --> 01:25:12.882 position:50% align:middle The candidates in each group have more in common with each other, 01:25:12.882 --> 01:25:15.366 position:50% align:middle have closer ability estimates to each other. 01:25:15.366 --> 01:25:22.420 position:50% align:middle So you can see throw a lot of items like this on the test, and we much more quickly arrive at a very 01:25:22.420 --> 01:25:24.479 position:50% align:middle precise ability estimate. 01:25:28.730 --> 01:25:31.360 position:50% align:middle Pardon me, I had to get a little drink there. 01:25:31.360 --> 01:25:34.310 position:50% align:middle So, what do I want to say? 01:25:34.310 --> 01:25:38.980 position:50% align:middle One of the questions that came early when I would do presentations is people would see all the stuff we were 01:25:38.980 --> 01:25:43.630 position:50% align:middle adding to the test and they say, oh, my gosh, this test is going to be really long. 01:25:43.630 --> 01:25:45.830 position:50% align:middle This is going to have a lot of items, right? 01:25:45.830 --> 01:25:51.263 position:50% align:middle One of the nice things about the partial credit scoring because it provides more information per item 01:25:51.263 --> 01:25:57.710 position:50% align:middle is we don't need as many items to get to the final ability estimate, to get into the pass-fail. 01:25:57.710 --> 01:26:00.700 position:50% align:middle We can do it more efficiently with fewer items. 01:26:00.700 --> 01:26:07.080 position:50% align:middle That's how the test is staying about the same, even while measuring new things like clinical judgment. 01:26:07.080 --> 01:26:09.710 position:50% align:middle Okay, appropriateness probably speaks for itself. 01:26:09.710 --> 01:26:13.550 position:50% align:middle You see a complicated item, it probably makes sense to you that we would look 01:26:13.550 --> 01:26:15.000 position:50% align:middle at partial credit. 01:26:15.000 --> 01:26:19.490 position:50% align:middle From the perspectives of students, I would say it's probably perceived as more fair. 01:26:19.490 --> 01:26:25.020 position:50% align:middle If you have someone who comes to you and says, no fair, I got all of them, but one and they gave me a zero. 01:26:25.020 --> 01:26:28.680 position:50% align:middle Well, that student will love the NGN. 01:26:28.680 --> 01:26:30.670 position:50% align:middle We're going to try this together. 01:26:30.670 --> 01:26:34.890 position:50% align:middle I am taking some samples from the first case study we looked at. 01:26:34.890 --> 01:26:38.340 position:50% align:middle It was the person hit by the baseball having some issues. 01:26:38.340 --> 01:26:42.540 position:50% align:middle And we are going to decide how should this be scored. 01:26:42.540 --> 01:26:44.430 position:50% align:middle And I know I gave you a crash course. 01:26:44.430 --> 01:26:46.098 position:50% align:middle This is going to be probably difficult. 01:26:46.098 --> 01:26:50.640 position:50% align:middle But partly me even sharing the answers will reinforce the learning. 01:26:50.640 --> 01:26:56.706 position:50% align:middle Okay, so we just saw very quickly three partial credit, pardon me, scoring methods, 01:26:56.706 --> 01:26:58.895 position:50% align:middle all fairly new, novel to you. 01:26:58.895 --> 01:27:00.600 position:50% align:middle But let's take a look. 01:27:00.600 --> 01:27:04.330 position:50% align:middle Drag the assessment findings that require immediate follow-up to the box on the right. 01:27:04.330 --> 01:27:07.980 position:50% align:middle And we can pretend that the candidate did this. 01:27:07.980 --> 01:27:12.930 position:50% align:middle First question, let's use the chat, is this going to be a +/-? 01:27:12.930 --> 01:27:14.430 position:50% align:middle If it is go ahead and type plus. 01:27:14.430 --> 01:27:15.645 position:50% align:middle Is it a 0/1? 01:27:15.645 --> 01:27:17.330 position:50% align:middle If it is, go ahead and type zero. 01:27:17.330 --> 01:27:21.970 position:50% align:middle Is it rationale scoring, if it is type rationale, or type R if you like. 01:27:21.970 --> 01:27:25.890 position:50% align:middle So what's the scoring method I should use here? 01:27:25.890 --> 01:27:28.890 position:50% align:middle Okay, I see a +/- from Aaron. 01:27:28.890 --> 01:27:30.940 position:50% align:middle I see +/- from Sharon. 01:27:30.940 --> 01:27:33.320 position:50% align:middle If your name rhymes with Aaron, you're getting it right. 01:27:33.320 --> 01:27:33.790 position:50% align:middle Okay. 01:27:33.790 --> 01:27:35.380 position:50% align:middle I see Gina as well. 01:27:35.380 --> 01:27:37.150 position:50% align:middle I'm seeing a lot of +/-. 01:27:37.150 --> 01:27:39.340 position:50% align:middle Yes, this group is amazing. 01:27:39.340 --> 01:27:47.480 position:50% align:middle It is +/-, because, right, somebody is able to select every single response, right? 01:27:47.480 --> 01:27:51.720 position:50% align:middle Somebody could, it would take a few more seconds, but somebody could drag everything over, right? 01:27:51.720 --> 01:27:54.410 position:50% align:middle So we have to build in the penalty. 01:27:54.410 --> 01:27:59.450 position:50% align:middle Well, now I'm going to tell you, out of the five things that were dragged four were 01:27:59.450 --> 01:28:00.840 position:50% align:middle right one was wrong. 01:28:00.840 --> 01:28:02.830 position:50% align:middle Who can tell me the final score? 01:28:02.830 --> 01:28:06.430 position:50% align:middle What score should I assign? 01:28:06.430 --> 01:28:10.270 position:50% align:middle Okay, I see a four, I see some threes. 01:28:10.270 --> 01:28:14.230 position:50% align:middle I see a few more threes. 01:28:14.230 --> 01:28:16.250 position:50% align:middle And a few more threes. 01:28:16.250 --> 01:28:18.300 position:50% align:middle Indeed, the answer is three. 01:28:18.300 --> 01:28:23.320 position:50% align:middle So remember, with +/- scoring, we're going to count up the correct which is four. 01:28:23.320 --> 01:28:28.300 position:50% align:middle But the whole point of the minus is we're going to take away a point when we see something wrong. 01:28:28.300 --> 01:28:31.050 position:50% align:middle So 4 minus 1 gets us to 3. 01:28:31.050 --> 01:28:34.840 position:50% align:middle Okay, again, I gave you the crash course really fast. 01:28:34.840 --> 01:28:39.800 position:50% align:middle I am seeing a great question about why aren't they penalized for not pulling over something 01:28:39.800 --> 01:28:40.390 position:50% align:middle that was correct? 01:28:40.390 --> 01:28:42.030 position:50% align:middle Let's pretend productive cough was correct. 01:28:42.030 --> 01:28:45.080 position:50% align:middle Well, they didn't pull that over shouldn't we deduct a point? 01:28:45.080 --> 01:28:47.480 position:50% align:middle Well, guess what we already did, right? 01:28:47.480 --> 01:28:51.410 position:50% align:middle If they had pulled it over, they would have earned a point for it. 01:28:51.410 --> 01:28:55.690 position:50% align:middle By leaving it there, they did not earn that point, they left that point on the table. 01:28:55.690 --> 01:29:01.250 position:50% align:middle So the point is we don't have to sort of give them a double whammy, we don't have to say hey, 01:29:01.250 --> 01:29:02.400 position:50% align:middle it's not there. 01:29:02.400 --> 01:29:07.170 position:50% align:middle We're not just not going to give you the point, we're also going to lower your score another notch. 01:29:07.170 --> 01:29:12.000 position:50% align:middle If you really sort of study the situation, you'll see that there was no need to do that because 01:29:12.000 --> 01:29:14.310 position:50% align:middle they already lost that point. 01:29:14.310 --> 01:29:18.310 position:50% align:middle I saw that question come up earlier while I was I think explaining the +/-. 01:29:18.310 --> 01:29:19.880 position:50% align:middle It's an excellent question. 01:29:19.880 --> 01:29:24.400 position:50% align:middle I had the same exact question myself when I was introduced to the scoring methods. 01:29:24.400 --> 01:29:26.510 position:50% align:middle Let's go to...oh, here we go. 01:29:26.510 --> 01:29:28.080 position:50% align:middle Here's the answer. 01:29:28.080 --> 01:29:29.600 position:50% align:middle Let's go to the next one. 01:29:29.600 --> 01:29:33.930 position:50% align:middle The nurse is speaking with the physician regarding the treatment plan for the client who was just diagnosed. 01:29:33.930 --> 01:29:39.723 position:50% align:middle Well, we saw this, right they had spleen laceration, and some monster from Jurassic Park. 01:29:39.723 --> 01:29:43.170 position:50% align:middle It looks like hemothorax souris. 01:29:43.170 --> 01:29:44.850 position:50% align:middle Okay, here we go. 01:29:44.850 --> 01:29:46.720 position:50% align:middle How do we want to score this one? 01:29:46.720 --> 01:29:51.340 position:50% align:middle It's all these potential orders that we need to check off as anticipated or contraindicated. 01:29:51.340 --> 01:29:53.640 position:50% align:middle What's our scoring method going to be? 01:29:53.640 --> 01:29:56.830 position:50% align:middle +/-, or 0/1, or rationale? 01:29:56.830 --> 01:29:58.486 position:50% align:middle Find a way to tell me in the chat. 01:30:01.530 --> 01:30:04.030 position:50% align:middle Okay, I'm seeing some 0/1s early on. 01:30:04.030 --> 01:30:05.780 position:50% align:middle I'm seeing some 0/1s early on. 01:30:05.780 --> 01:30:08.707 position:50% align:middle I'm seeing some rationale or one rationale so far. 01:30:08.707 --> 01:30:09.999 position:50% align:middle 0/1. 01:30:14.389 --> 01:30:16.008 position:50% align:middle I'm seeing more 0/1. 01:30:16.008 --> 01:30:23.921 position:50% align:middle I had to think about this one a lot because I can check off every choice for anticipate. 01:30:23.921 --> 01:30:25.450 position:50% align:middle I can say everything is anticipated. 01:30:25.450 --> 01:30:27.820 position:50% align:middle So I thought, oh, I better build in a penalty. 01:30:27.820 --> 01:30:30.790 position:50% align:middle But here's really what it comes down to. 01:30:30.790 --> 01:30:36.010 position:50% align:middle The computer is not going to let me check off everything in the anticipated column and everything 01:30:36.010 --> 01:30:36.690 position:50% align:middle in the contraindicated. 01:30:36.690 --> 01:30:42.960 position:50% align:middle In other words, there are 16 bubbles looking at you, if I could check off all 16 bubbles, of course, 01:30:42.960 --> 01:30:45.290 position:50% align:middle we need some sort of minus, right? 01:30:45.290 --> 01:30:46.110 position:50% align:middle Yes. 01:30:46.110 --> 01:30:48.250 position:50% align:middle Oh, my gosh, Mary has said it perfectly. 01:30:48.250 --> 01:30:52.080 position:50% align:middle They can't check off all 16 bubbles, therefore, no penalty needed. 01:30:52.080 --> 01:30:55.070 position:50% align:middle 0/1 is going to work in this case. 01:30:55.070 --> 01:30:58.800 position:50% align:middle So let's pretend here's their answer. 01:30:58.800 --> 01:31:03.000 position:50% align:middle And one at a time. I didn't know that. 01:31:03.000 --> 01:31:06.420 position:50% align:middle Okay, well, now we're going to evaluate every row is either right or wrong. 01:31:06.420 --> 01:31:10.840 position:50% align:middle And it looks like there are three correct and five incorrect. 01:31:10.840 --> 01:31:12.560 position:50% align:middle What is their final score? 01:31:16.911 --> 01:31:18.640 position:50% align:middle I'm checking the chat. 01:31:18.640 --> 01:31:20.550 position:50% align:middle I see three. 01:31:20.550 --> 01:31:22.090 position:50% align:middle I see three out of eight. 01:31:22.090 --> 01:31:23.030 position:50% align:middle I see three. 01:31:23.030 --> 01:31:24.420 position:50% align:middle I see three. 01:31:24.420 --> 01:31:26.890 position:50% align:middle I'm seeing more threes. 01:31:26.890 --> 01:31:29.320 position:50% align:middle Guess what this group is amazing. 01:31:29.320 --> 01:31:32.050 position:50% align:middle It is in fact three, right? 01:31:32.050 --> 01:31:34.840 position:50% align:middle It could be tempting to say should I do 3 minus 5? 01:31:34.840 --> 01:31:41.470 position:50% align:middle But again, we already established it is not a +/- scoring, therefore, we just count up the stars. 01:31:41.470 --> 01:31:43.120 position:50% align:middle So it's just plain three. 01:31:43.120 --> 01:31:48.080 position:50% align:middle And the person who said three out of eight who's scrolled away past, what I'm looking at, 01:31:48.080 --> 01:31:49.980 position:50% align:middle is in fact entirely correct. 01:31:49.980 --> 01:31:55.600 position:50% align:middle This item literally could be worth up to...well, it is worth up to eight points. 01:31:55.600 --> 01:31:58.870 position:50% align:middle You could get eight out of eight on this if you did everything perfectly. 01:31:58.870 --> 01:32:00.420 position:50% align:middle Okay. 01:32:00.420 --> 01:32:03.550 position:50% align:middle This candidate would get three, get the math there. 01:32:03.550 --> 01:32:07.660 position:50% align:middle Let's go to the...I believe this is my final example for scoring. 01:32:07.660 --> 01:32:10.100 position:50% align:middle Okay, click to highlight the findings below. 01:32:10.100 --> 01:32:11.520 position:50% align:middle Okay, we've seen this. 01:32:11.520 --> 01:32:19.480 position:50% align:middle Let's pretend that this particular candidate clicks on this, able to ambulate, 01:32:19.480 --> 01:32:25.790 position:50% align:middle clicks on this, refuses the spirometer. I've been there, I can relate, that's no fun. 01:32:25.790 --> 01:32:27.990 position:50% align:middle And adequate urine output. 01:32:27.990 --> 01:32:32.790 position:50% align:middle Okay, so these three things are clicked on. 01:32:32.790 --> 01:32:33.780 position:50% align:middle Well, let's do this. 01:32:33.780 --> 01:32:38.170 position:50% align:middle First off, can you tell me the scoring method already, even before I tell you whether anything is 01:32:38.170 --> 01:32:38.850 position:50% align:middle right or wrong? 01:32:38.850 --> 01:32:42.020 position:50% align:middle Scoring method here I am seeing from Aaron a plus. 01:32:42.020 --> 01:32:43.710 position:50% align:middle So +/- from Aaron. 01:32:43.710 --> 01:32:45.660 position:50% align:middle Anybody else? 01:32:45.660 --> 01:32:47.530 position:50% align:middle Rationale I'm seeing from Don. 01:32:47.530 --> 01:32:50.440 position:50% align:middle Okay, I'm seeing rationale again. 01:32:50.440 --> 01:32:52.143 position:50% align:middle I'm seeing rationale again. 01:32:52.590 --> 01:32:58.140 position:50% align:middle Okay, let's wait for one more answer. Somebody else type in. 01:32:58.140 --> 01:33:01.320 position:50% align:middle Oh, a question from Aaron, could I highlight the whole thing? 01:33:01.320 --> 01:33:03.950 position:50% align:middle I could highlight as many things as I want. 01:33:03.950 --> 01:33:05.850 position:50% align:middle Yes, Aaron, I could do that. 01:33:05.850 --> 01:33:08.870 position:50% align:middle I'm seeing 0/1, I'm seeing plus, and I'm seeing more rationale. 01:33:08.870 --> 01:33:11.138 position:50% align:middle So this was kind of a challenging one. 01:33:11.138 --> 01:33:13.907 position:50% align:middle We've seen all three suggested. 01:33:13.907 --> 01:33:19.520 position:50% align:middle So let me mention...I'll give the correct answer and why I believe it's the case. 01:33:19.520 --> 01:33:24.640 position:50% align:middle You could click every statement, therefore we do need to build in a penalty. 01:33:24.640 --> 01:33:27.120 position:50% align:middle Therefore, +/-, not 0/1. 01:33:27.120 --> 01:33:33.640 position:50% align:middle Now, sometimes...I think if you're writing rationale, you may be looking at things like the client is 01:33:33.640 --> 01:33:37.870 position:50% align:middle refusing to use the spirometer because it causes pain, right? 01:33:37.870 --> 01:33:41.300 position:50% align:middle So there's a little bit of a rationale from the client's perspective. 01:33:41.300 --> 01:33:48.725 position:50% align:middle But from a scoring perspective, are there multiple pieces of the response 01:33:48.725 --> 01:33:50.978 position:50% align:middle that we want to group into a single thing? 01:33:50.978 --> 01:33:53.249 position:50% align:middle Here I would say probably not. 01:33:53.249 --> 01:33:55.940 position:50% align:middle That could be a judgment call that can be subjective. 01:33:55.940 --> 01:34:00.660 position:50% align:middle But here, I think we're in a position to evaluate each click on its own. 01:34:00.660 --> 01:34:04.960 position:50% align:middle Example, this first thing, wrong. 01:34:04.960 --> 01:34:07.300 position:50% align:middle This second thing, correct. 01:34:07.300 --> 01:34:09.130 position:50% align:middle This third thing wrong. 01:34:09.130 --> 01:34:15.630 position:50% align:middle So keeping in mind, we're using +/- scoring, who can tell me the final score for this candidate? 01:34:15.630 --> 01:34:19.940 position:50% align:middle I am seeing a couple of zeros, I'm seeing another zero. 01:34:19.940 --> 01:34:22.550 position:50% align:middle I'm seeing a lot of zeros. 01:34:22.550 --> 01:34:23.520 position:50% align:middle Goose eggs all around. 01:34:23.520 --> 01:34:26.600 position:50% align:middle If it were baseball it would be a shutout only, there's no season. 01:34:26.650 --> 01:34:29.370 position:50% align:middle I'm seeing a -1, which I'm happy to see. 01:34:29.370 --> 01:34:34.480 position:50% align:middle I'm seeing another -1, which I'm very happy to see, because, right, as we call it, 01:34:34.480 --> 01:34:36.930 position:50% align:middle a teachable moment. 01:34:36.930 --> 01:34:44.430 position:50% align:middle So we have the +/- scoring and here's that part I said was going to be on the quiz, right? 01:34:44.430 --> 01:34:46.890 position:50% align:middle And I know how fast I've given you all this information. 01:34:46.890 --> 01:34:51.210 position:50% align:middle Do not worry if you're not a scoring expert yet, or even ever because we do the scoring. 01:34:51.210 --> 01:34:58.010 position:50% align:middle But point is, if we just counted up, we get 1 minus 2 and so we do get -1, right? 01:34:58.010 --> 01:35:06.190 position:50% align:middle However, remember that last detail of +/- scoring is that we never go negative, right? 01:35:06.190 --> 01:35:09.480 position:50% align:middle The lowest score we can give is a zero. 01:35:09.480 --> 01:35:13.880 position:50% align:middle So -1 on some level is kind of technically more correct. 01:35:13.880 --> 01:35:15.970 position:50% align:middle However, we would give a zero here. 01:35:15.970 --> 01:35:16.450 position:50% align:middle There you go. 01:35:16.450 --> 01:35:21.190 position:50% align:middle So I'm glad I saw some each final score zero. 01:35:21.190 --> 01:35:27.720 position:50% align:middle Okay, y'all, you asked so many questions, I went a little faster than usual through the scoring. 01:35:27.720 --> 01:35:31.670 position:50% align:middle Please forgive me. We'll see what we can do from here. 01:35:31.670 --> 01:35:33.460 position:50% align:middle Resources, let me be quick here, too. 01:35:33.460 --> 01:35:36.678 position:50% align:middle We have a website, of course, ncsbn.org. 01:35:36.678 --> 01:35:40.470 position:50% align:middle Upper left-hand corner, NCLEX, and other exams. 01:35:40.470 --> 01:35:45.230 position:50% align:middle Go down the list you get to and you'll see next-generation NCLEX. 01:35:45.230 --> 01:35:50.530 position:50% align:middle And within that, I love to click on NGN resources because it takes me to these newsletters. 01:35:50.530 --> 01:35:55.420 position:50% align:middle I really believe for educators, these newsletters are solid gold, 01:35:55.420 --> 01:35:57.500 position:50% align:middle especially case study. 01:35:57.500 --> 01:35:59.550 position:50% align:middle If you only read one read case study. 01:35:59.550 --> 01:36:03.340 position:50% align:middle But my advice if you can find the time, read them all. 01:36:03.340 --> 01:36:07.600 position:50% align:middle These are excellent because just like this presentation, they just pick a topic and tell you what 01:36:07.600 --> 01:36:11.950 position:50% align:middle you need to know and show you examples, and do a good job explaining, right? 01:36:11.950 --> 01:36:14.950 position:50% align:middle This new one I mentioned is pretty thick. 01:36:14.950 --> 01:36:19.340 position:50% align:middle And so, you know, some of these you can read in five minutes, some of these you might need 20. 01:36:19.340 --> 01:36:22.100 position:50% align:middle But okay, what else? 01:36:22.100 --> 01:36:29.860 position:50% align:middle For those of you with more of a research and academic bent, we have sort of academic journal-type papers, 01:36:29.860 --> 01:36:31.790 position:50% align:middle you've seen these, I'm sure, 01:36:31.790 --> 01:36:36.070 position:50% align:middle including at the very beginning, it feels like yesterday, but a couple of hours ago, 01:36:36.070 --> 01:36:38.380 position:50% align:middle I mentioned our literature review. 01:36:38.380 --> 01:36:40.700 position:50% align:middle We mentioned that Strategic Practice Analysis. 01:36:40.700 --> 01:36:45.680 position:50% align:middle Some of these foundational documents in terms of the research and the rationale for the exam are also 01:36:45.680 --> 01:36:49.040 position:50% align:middle available through our website. 01:36:49.040 --> 01:36:53.390 position:50% align:middle With that, oh, gosh, I am going to do my best. 01:36:53.390 --> 01:36:56.030 position:50% align:middle The chatbox...this is the nature of these presentations. 01:36:56.030 --> 01:37:00.500 position:50% align:middle The chatbox, of course, is a mix now of you helping me write items and score 01:37:00.500 --> 01:37:02.030 position:50% align:middle items and questions you've asked. 01:37:02.030 --> 01:37:05.430 position:50% align:middle So I'm going to do my best to scroll through. 01:37:05.430 --> 01:37:10.730 position:50% align:middle I'm going to also stop my sharing, and I'll be perhaps a little bit bigger on your screen. 01:37:10.730 --> 01:37:13.170 position:50% align:middle Let me see what I can do here. 01:37:13.170 --> 01:37:17.120 position:50% align:middle Okay, so from Vivian, are reference ranges given for all? 01:37:17.120 --> 01:37:19.590 position:50% align:middle And the answer here is yes. 01:37:19.590 --> 01:37:23.370 position:50% align:middle So that is something that no longer would need to be memorized. 01:37:23.370 --> 01:37:27.522 position:50% align:middle Now warning, the new exam launches in April 2023. 01:37:27.522 --> 01:37:34.530 position:50% align:middle If you have somebody taking the NCLEX this May or June, or July, they still need to know these things, right? 01:37:34.530 --> 01:37:38.950 position:50% align:middle So it's a shift coming in April 2023. Reference range is provided. 01:37:38.950 --> 01:37:43.450 position:50% align:middle Now that of course applies to things like the case studies to be more realistic. 01:37:43.450 --> 01:37:47.090 position:50% align:middle But if you really think about it, it has a ripple effect across the exam, 01:37:47.090 --> 01:37:51.980 position:50% align:middle because what would be the point of having somebody memorize all these ranges if when they come to our 01:37:51.980 --> 01:37:55.410 position:50% align:middle case study, they can just copy them down on their whiteboard, right? 01:37:55.410 --> 01:38:01.820 position:50% align:middle So the point is, there's impact across even the normal NCLEX, if I can call it that. 01:38:01.820 --> 01:38:05.710 position:50% align:middle Diana asks, is drag and drop ADA compliant? 01:38:05.710 --> 01:38:06.710 position:50% align:middle Fantastic question. 01:38:06.710 --> 01:38:13.880 position:50% align:middle So we had some specialists or experts, I guess I should say, with ADA review the new item types. 01:38:13.880 --> 01:38:16.584 position:50% align:middle And what they determined, as I think you've anticipated, is 01:38:16.584 --> 01:38:19.810 position:50% align:middle not all of them were appropriate for all populations. 01:38:19.810 --> 01:38:25.860 position:50% align:middle Therefore, just like there are accommodations available on the NCLEX today, the next generation NCLEX will 01:38:25.860 --> 01:38:32.930 position:50% align:middle support accommodations that include, in particular, potentially getting an exam that doesn't have a 01:38:32.930 --> 01:38:34.350 position:50% align:middle certain item type. 01:38:34.350 --> 01:38:40.510 position:50% align:middle So I'm sorry that I haven't memorized which ones are which so I won't guess, 01:38:40.510 --> 01:38:43.960 position:50% align:middle specifically with drag and drop, but I know that was definitely one that was 01:38:43.960 --> 01:38:44.680 position:50% align:middle looked at closely. 01:38:44.680 --> 01:38:50.530 position:50% align:middle The point is, there would be modifications for particular candidates. 01:38:50.530 --> 01:38:53.900 position:50% align:middle NGN, same number of questions as the current exam, how much time? 01:38:53.900 --> 01:38:55.220 position:50% align:middle So that came under test design. 01:38:55.220 --> 01:39:00.340 position:50% align:middle What you saw is that, potentially, it could have five more questions, potentially, it could have five more, 01:39:00.340 --> 01:39:01.360 position:50% align:middle it's always variable. 01:39:01.360 --> 01:39:03.550 position:50% align:middle So different people can get different numbers. 01:39:03.550 --> 01:39:07.200 position:50% align:middle But at the maximum end, the NGN would have five more questions 01:39:07.200 --> 01:39:08.320 position:50% align:middle than the current exam. 01:39:08.320 --> 01:39:12.960 position:50% align:middle The time would remain the same five hours, that's our NNPN. 01:39:12.960 --> 01:39:18.390 position:50% align:middle Teresa asks, will the terminology be changed to prescription order? 01:39:18.390 --> 01:39:19.170 position:50% align:middle I get this a lot. 01:39:19.170 --> 01:39:22.150 position:50% align:middle I'm always scared I'm going to confuse it as a non-nurse. 01:39:22.150 --> 01:39:25.130 position:50% align:middle Let me tell you because I get it so much and I answer it so much. 01:39:25.130 --> 01:39:30.790 position:50% align:middle So I don't have notes in front of me, but I believe when we say prescription, 01:39:30.790 --> 01:39:35.010 position:50% align:middle we will very specifically be thinking of medications. 01:39:35.010 --> 01:39:38.330 position:50% align:middle When we say order, it's kind of a broader class, right? 01:39:38.330 --> 01:39:44.330 position:50% align:middle It might include like, getting an x-ray or a CT scan, but it could include medications. 01:39:44.330 --> 01:39:50.090 position:50% align:middle In other words, order is kind of just this bigger category of which prescription would sort of point 01:39:50.090 --> 01:39:52.440 position:50% align:middle to a smaller subset. 01:39:52.440 --> 01:39:54.530 position:50% align:middle I think I have that right. 01:39:54.530 --> 01:39:55.820 position:50% align:middle Okay. 01:39:55.820 --> 01:39:57.740 position:50% align:middle How many case studies? 01:39:57.740 --> 01:40:00.560 position:50% align:middle And you saw that answered with the test design slide. 01:40:00.560 --> 01:40:06.270 position:50% align:middle Three case studies that count, however, a lucky or unlucky candidate you decide, 01:40:06.270 --> 01:40:11.300 position:50% align:middle not me could see one that doesn't count, they could even see two that don't count, 01:40:11.300 --> 01:40:14.510 position:50% align:middle although that would be a lower probability. 01:40:14.510 --> 01:40:18.930 position:50% align:middle Okay, from Linda, would the student be able to backtrack to the previous questions? 01:40:18.930 --> 01:40:20.310 position:50% align:middle I'm so glad somebody asked that. 01:40:20.310 --> 01:40:21.410 position:50% align:middle Linda, thank you. 01:40:21.410 --> 01:40:25.972 position:50% align:middle So the way a CAT exam works, is it's a one-way street, you can never go backwards. 01:40:25.972 --> 01:40:27.198 position:50% align:middle That's the bad news. 01:40:27.198 --> 01:40:32.900 position:50% align:middle So you can't skip a question, you can't, you know, do something else and go back and hope to change 01:40:32.900 --> 01:40:34.490 position:50% align:middle an answer or something like that. 01:40:34.490 --> 01:40:36.580 position:50% align:middle It's a one-way street, you can only go forward. 01:40:36.580 --> 01:40:38.150 position:50% align:middle Here's the good news. 01:40:38.150 --> 01:40:43.410 position:50% align:middle In the case study, all the information on that left-hand side stays there, it doesn't go away. 01:40:43.410 --> 01:40:45.880 position:50% align:middle You don't have to say, oh, I wish I remembered what it said in that 01:40:45.880 --> 01:40:47.220 position:50% align:middle first one, right? 01:40:47.220 --> 01:40:51.870 position:50% align:middle It just stays there and if anything, it gets bigger, right, an extra tab might get added. 01:40:51.870 --> 01:40:54.200 position:50% align:middle But we don't take any of that information away. 01:40:54.200 --> 01:41:00.320 position:50% align:middle Therefore, you don't have to go back to the previous question to read it, it stays with you. 01:41:00.320 --> 01:41:05.090 position:50% align:middle Let's see, can some share...so this was a question for each other in terms of LMS. 01:41:05.090 --> 01:41:08.010 position:50% align:middle So I'm going to leave that with y'all. 01:41:08.010 --> 01:41:11.890 position:50% align:middle At NCSBN, we do our best not to endorse or recommend or anything like that. 01:41:11.890 --> 01:41:17.050 position:50% align:middle But certainly, when people are thinking resources, I would certainly say wherever resources are 01:41:17.050 --> 01:41:21.640 position:50% align:middle coming from today, talk to those folks and ask them what they have going on with NGN. 01:41:21.640 --> 01:41:26.010 position:50% align:middle If you don't like the answer, well, you could talk to somebody else, you know. 01:41:26.010 --> 01:41:30.300 position:50% align:middle But the point is, at NCSBN, we don't point to a particular provider or anything 01:41:30.300 --> 01:41:33.050 position:50% align:middle like that, whether it's LMS, or test prep, or anything. 01:41:33.050 --> 01:41:34.950 position:50% align:middle So I apologize for that. 01:41:34.950 --> 01:41:39.020 position:50% align:middle Kathy says is the percent of standalone items after the minimum number still 10%? 01:41:39.020 --> 01:41:45.490 position:50% align:middle I'm going to say there, and I apologize, I mentioned our latest newsletter is quite thick. 01:41:45.490 --> 01:41:50.440 position:50% align:middle I've read it twice but I'm still...you know, I'm not confident enough to answer your question other 01:41:50.440 --> 01:41:55.050 position:50% align:middle than to say that newsletter definitely answers your question. 01:41:55.050 --> 01:42:03.660 position:50% align:middle I will confess I don't quite remember if it's 10% after the minimum number, or if it's 10% of the whole thing. 01:42:03.660 --> 01:42:09.790 position:50% align:middle I do know because there's some randomness that 10% shouldn't be taken as exact either way. 01:42:09.790 --> 01:42:14.740 position:50% align:middle There's always some variability with that percentage. 01:42:14.740 --> 01:42:15.450 position:50% align:middle Okay. 01:42:15.450 --> 01:42:18.020 position:50% align:middle Will all select all that apply from Vivian. 01:42:18.020 --> 01:42:19.890 position:50% align:middle Will all of them go up to eight choices? 01:42:19.890 --> 01:42:20.590 position:50% align:middle No. 01:42:20.590 --> 01:42:26.480 position:50% align:middle By the way, you did see a lot of eight response option questions here, nothing magic about eight. 01:42:26.480 --> 01:42:30.500 position:50% align:middle If you saw 8, it could have been 7, it could have been 9, it could have been 10. 01:42:30.500 --> 01:42:34.970 position:50% align:middle Picture one of these on today's NCLEX that has five response options. 01:42:34.970 --> 01:42:39.820 position:50% align:middle If we're still using it in a year, good chance we are, it'll still have five. 01:42:39.820 --> 01:42:43.880 position:50% align:middle We're not going to add extra choices to items we already have. 01:42:43.880 --> 01:42:50.930 position:50% align:middle However, what will change is we will apply the partial credit scoring to the items we already have. 01:42:50.930 --> 01:42:55.150 position:50% align:middle Okay, oh, things are starting to scroll up on me as people are typing in new things. 01:42:55.150 --> 01:42:56.490 position:50% align:middle Let me see what I can find. 01:42:56.490 --> 01:43:01.270 position:50% align:middle Okay, Lorraine asks for Satta. 01:43:01.270 --> 01:43:05.300 position:50% align:middle Can one or all options be correct? 01:43:05.300 --> 01:43:07.510 position:50% align:middle Answer there, yes. 01:43:07.510 --> 01:43:10.850 position:50% align:middle I think they're most interesting when they have more than one correct. 01:43:10.850 --> 01:43:15.740 position:50% align:middle But technically, if somebody wrote one with only one correct, we would not use that as a basis 01:43:15.740 --> 01:43:17.780 position:50% align:middle to reject the item. 01:43:17.780 --> 01:43:19.410 position:50% align:middle It would be eligible. 01:43:19.410 --> 01:43:20.830 position:50% align:middle Okay. 01:43:20.830 --> 01:43:21.830 position:50% align:middle Whitney asks. 01:43:21.830 --> 01:43:25.710 position:50% align:middle Yeah, they don't get a point off for not selecting the U.S. 01:43:25.710 --> 01:43:26.250 position:50% align:middle So good. 01:43:26.250 --> 01:43:28.940 position:50% align:middle Yeah, I'm so glad that that question got asked. 01:43:28.940 --> 01:43:34.430 position:50% align:middle The whole idea, if you really analyze the problem is they already lost that point. 01:43:34.430 --> 01:43:37.130 position:50% align:middle If you really think about it, they didn't get that point. 01:43:37.130 --> 01:43:42.080 position:50% align:middle You remember, in the example, I showed, the person got one point they got...it was like 2 01:43:42.080 --> 01:43:46.820 position:50% align:middle minus 1 equals 1 but it was one point out of three. 01:43:46.820 --> 01:43:48.950 position:50% align:middle If they had dragged U.S. they would have gotten two. 01:43:48.950 --> 01:43:53.430 position:50% align:middle Therefore you can almost think about it like, the negative did happen. 01:43:53.430 --> 01:43:56.240 position:50% align:middle Okay, let's see what else. 01:43:56.240 --> 01:43:58.940 position:50% align:middle Whitney, they don't get a point...same okay. 01:43:58.940 --> 01:44:01.040 position:50% align:middle I'm sorry, I just read that. 01:44:01.040 --> 01:44:01.400 position:50% align:middle Okay. 01:44:01.400 --> 01:44:10.210 position:50% align:middle Terry, will there be questions where the student must get all the answers correct to get the points? 01:44:10.210 --> 01:44:14.710 position:50% align:middle Okay, I have to think a little bit. It's a little bit outside the box for me. 01:44:14.710 --> 01:44:16.930 position:50% align:middle I'm going to say in general, no. 01:44:16.930 --> 01:44:20.410 position:50% align:middle When we say partial credit, we mean partial credit. 01:44:20.410 --> 01:44:25.820 position:50% align:middle Now, there's some exceptions, for example, think of just an ordinary multiple-choice question. 01:44:25.820 --> 01:44:29.470 position:50% align:middle Well, for a multiple-choice, you know what, there is no partial credit. 01:44:29.470 --> 01:44:34.570 position:50% align:middle So a multiple choice is sort of a non-interesting example of where there's no partial credit. 01:44:34.570 --> 01:44:40.340 position:50% align:middle But in general, anything that looks like it's probably worth partial credit, it really is. 01:44:40.340 --> 01:44:44.020 position:50% align:middle There aren't interesting exceptions, I guess I'll say. 01:44:44.020 --> 01:44:45.690 position:50% align:middle Okay. 01:44:45.690 --> 01:44:56.620 position:50% align:middle Liz is asking, this question is three possible correct answers, but only two options, 01:44:56.620 --> 01:44:59.370 position:50% align:middle would there ever be this possibility, NGN? 01:44:59.370 --> 01:45:01.120 position:50% align:middle Liz, you may not remember anymore. 01:45:01.120 --> 01:45:05.190 position:50% align:middle But if you know which item you're referring to give me a hint and then I'll do my best. 01:45:05.190 --> 01:45:09.860 position:50% align:middle At the moment I'm not totally sure that I understand, so I apologize. 01:45:09.860 --> 01:45:13.587 position:50% align:middle But if you can remember the item that may help me. 01:45:14.840 --> 01:45:20.150 position:50% align:middle Okay, let's see what else I have. 01:45:20.150 --> 01:45:26.530 position:50% align:middle Okay, Mary says, I thought for now, only on the NGN questions were reference ranges and 01:45:26.530 --> 01:45:28.260 position:50% align:middle not current questions. 01:45:28.260 --> 01:45:30.150 position:50% align:middle Right yeah, Mary, it's a really good point. 01:45:30.150 --> 01:45:32.940 position:50% align:middle Today on the exam, we don't provide any reference ranges. 01:45:32.940 --> 01:45:38.320 position:50% align:middle But what we anticipate for the future is that if we're providing all these reference ranges in the 01:45:38.320 --> 01:45:45.540 position:50% align:middle case studies, then it's kind of pointless to ask for memorization in the ordinary items, 01:45:45.540 --> 01:45:51.277 position:50% align:middle because we don't want candidates wasting their time copying down every single reference range 01:45:51.277 --> 01:45:53.600 position:50% align:middle in a case study thinking they got a freebie, right? 01:45:53.600 --> 01:46:03.150 position:50% align:middle The whole point is, we're going real-world here even with a ripple effect on to the ordinary items. 01:46:03.150 --> 01:46:06.470 position:50% align:middle Okay, let's see where. 01:46:06.470 --> 01:46:11.010 position:50% align:middle Okay, so many are coming in, I'm doing my best to not lose anything. 01:46:11.010 --> 01:46:14.740 position:50% align:middle Okay, how can I obtain the NGN resources? 01:46:14.740 --> 01:46:20.550 position:50% align:middle Well, the short answer is the ones that I highlighted, obviously, on our website is where we keep all of that. 01:46:20.550 --> 01:46:28.330 position:50% align:middle In terms of things like people have asked me are there, you know...what curriculum from the big publishers 01:46:28.330 --> 01:46:29.990 position:50% align:middle already has all this stuff? 01:46:29.990 --> 01:46:34.160 position:50% align:middle Again, that's where at NCSBN we don't point anybody to anything other than, I do say 01:46:34.160 --> 01:46:38.590 position:50% align:middle follow up with where materials come from today to find out what that roadmap is. 01:46:38.590 --> 01:46:42.380 position:50% align:middle I do know from publishers who've talked to me some things are already out, 01:46:42.380 --> 01:46:47.370 position:50% align:middle and some other things have the "coming soon label" I suppose. 01:46:47.370 --> 01:46:51.650 position:50% align:middle Okay. Let's see. 01:46:51.650 --> 01:46:54.400 position:50% align:middle They're still coming fast. I'm doing my best y'all. 01:46:54.400 --> 01:46:58.330 position:50% align:middle Answers can be changed on one part of the question when working on the same question, correct? 01:46:58.330 --> 01:47:00.050 position:50% align:middle Yes, absolutely. 01:47:00.050 --> 01:47:04.230 position:50% align:middle Until you submit the entire item you can change whatever you want. 01:47:04.230 --> 01:47:05.410 position:50% align:middle Absolutely. 01:47:05.410 --> 01:47:06.550 position:50% align:middle Okay. 01:47:06.550 --> 01:47:08.310 position:50% align:middle Question above was skipped. 01:47:08.310 --> 01:47:09.120 position:50% align:middle Okay. 01:47:09.120 --> 01:47:10.380 position:50% align:middle Oh, sorry about that, Aaron. 01:47:10.380 --> 01:47:14.261 position:50% align:middle So the RN was always interacting with an MD, 01:47:14.261 --> 01:47:17.500 position:50% align:middle in the NGN, will they sometimes be working with an APRN? 01:47:17.500 --> 01:47:18.980 position:50% align:middle Oh, my God, excellent question. 01:47:18.980 --> 01:47:22.190 position:50% align:middle This is something that I learned and nobody had asked me about before. 01:47:22.190 --> 01:47:27.930 position:50% align:middle But yes, I think today on the exam, we use a phrase like primary healthcare provider a lot, 01:47:27.930 --> 01:47:29.050 position:50% align:middle something like that. 01:47:29.050 --> 01:47:37.800 position:50% align:middle On the NGN again, authenticity, you may see words like nurse practitioner, physician, surgeon, etc. 01:47:37.800 --> 01:47:44.040 position:50% align:middle Sort of different members of the healthcare team, or different titles, or licenses, etc. 01:47:44.040 --> 01:47:44.790 position:50% align:middle You get the idea. 01:47:44.790 --> 01:47:47.450 position:50% align:middle So the short answer for you is yes. 01:47:47.450 --> 01:47:50.383 position:50% align:middle I don't know that we would say APRN. 01:47:50.383 --> 01:47:53.802 position:50% align:middle I think we might say, nurse practitioner but the general idea is yes. 01:47:55.037 --> 01:47:56.941 position:50% align:middle Is that drop-down Cloze? 01:47:58.280 --> 01:47:59.050 position:50% align:middle Yes. 01:47:59.050 --> 01:48:05.400 position:50% align:middle So whenever you see a drop-down menu item, it is a cloze item also. 01:48:05.400 --> 01:48:08.400 position:50% align:middle I would just call it a pull-down menu or a drop-down menu item. 01:48:08.400 --> 01:48:14.930 position:50% align:middle But technically, it's sort of in a class of items called cloze items if you talk to measurement experts. 01:48:14.930 --> 01:48:20.270 position:50% align:middle Okay, Vivian with a thank you, which I really appreciate. 01:48:20.270 --> 01:48:24.840 position:50% align:middle And then in terms of a case study, there's all the information on the left, 01:48:24.840 --> 01:48:27.460 position:50% align:middle do they have to toggle back and forth? 01:48:29.559 --> 01:48:31.361 position:50% align:middle Yeah, right. 01:48:31.361 --> 01:48:35.806 position:50% align:middle So pretend that the case study, one of the ones we saw had this, has four tabs. 01:48:35.806 --> 01:48:40.980 position:50% align:middle All four tabs are available all the time, right? 01:48:40.980 --> 01:48:45.152 position:50% align:middle You might be on item five, and a new tab showed up and it's... 01:48:45.152 --> 01:48:48.890 position:50% align:middle I'll call it the active tab or the tab that's opened by default. 01:48:48.890 --> 01:48:51.730 position:50% align:middle But yeah, you can click on any of the other tabs and they show up too. 01:48:51.730 --> 01:48:56.680 position:50% align:middle So you don't lose anything on the tabs. 01:48:56.680 --> 01:48:59.780 position:50% align:middle If you're looking at lab results, and now you want nurses' notes, 01:48:59.780 --> 01:49:02.090 position:50% align:middle well now you gotta click that nurses' notes tab, right. 01:49:02.090 --> 01:49:05.710 position:50% align:middle It won't read your mind, but the information is all there. 01:49:05.710 --> 01:49:10.240 position:50% align:middle The example with countries as their capitals. 01:49:10.240 --> 01:49:12.340 position:50% align:middle Okay, thank you so much for that. 01:49:12.340 --> 01:49:16.670 position:50% align:middle That one...I'm glad it was geography because then I really remember the question. 01:49:16.670 --> 01:49:23.810 position:50% align:middle So question was, yeah, there were three possible but only two options. 01:49:23.810 --> 01:49:24.697 position:50% align:middle You make a good point. 01:49:24.697 --> 01:49:27.727 position:50% align:middle I would say that would be atypical for NGN. 01:49:27.727 --> 01:49:32.950 position:50% align:middle I think for NGN, we would probably go ahead and sort of max out, right? 01:49:32.950 --> 01:49:36.740 position:50% align:middle Yeah, there could have been three correct statements with countries and capitals. 01:49:36.740 --> 01:49:41.890 position:50% align:middle And I just asked for two to keep my scoring teaching short. 01:49:41.890 --> 01:49:45.260 position:50% align:middle So yeah, that's a great observation. 01:49:45.260 --> 01:49:49.080 position:50% align:middle Okay, I take it there will be delegation prioritizing questions. 01:49:49.080 --> 01:49:54.150 position:50% align:middle Are there more mid-surge questions or does it vary by student? 01:49:54.150 --> 01:49:58.200 position:50% align:middle Oh, gosh, I'm going to ask a favor of Jasmine. 01:49:58.200 --> 01:50:03.980 position:50% align:middle I always get a little scared on these that, you know, I know some of the terms in terms of delegation have 01:50:03.980 --> 01:50:08.820 position:50% align:middle very precise meaning that an ordinary non-nurse like me, could slightly get wrong. 01:50:08.820 --> 01:50:16.160 position:50% align:middle If possible, if Jasmine could email me this question, I would like to get a response from my team members, 01:50:16.160 --> 01:50:19.720 position:50% align:middle and then find a way to route it back to all of you who attended. 01:50:19.720 --> 01:50:23.510 position:50% align:middle But I'm a little scared to answer it now because I'm worried I could get it wrong. 01:50:23.510 --> 01:50:27.100 position:50% align:middle I don't want to give you the wrong information. 01:50:27.100 --> 01:50:35.360 position:50% align:middle Okay, good to know, in terms of the reference ranges. 01:50:35.360 --> 01:50:40.210 position:50% align:middle It looks like generic med names, still the only med name? 01:50:40.210 --> 01:50:41.270 position:50% align:middle Yes. 01:50:41.270 --> 01:50:45.220 position:50% align:middle And in terms of authenticity, that may be a break, right? 01:50:45.220 --> 01:50:49.950 position:50% align:middle In some places, maybe the trade names are what comes up more often. 01:50:49.950 --> 01:50:55.900 position:50% align:middle But here, we made a decision to go generic, I think, for a few reasons with the NCLEX many years ago, 01:50:55.900 --> 01:50:58.810 position:50% align:middle and we are sticking with it even for NGN. 01:50:58.810 --> 01:51:03.330 position:50% align:middle Okay, did not see the newsletters from Kay Anderson. 01:51:03.330 --> 01:51:09.680 position:50% align:middle So, yeah, ncsbn.org, you probably see the NCLEX and other exams in the upper left-hand corner. 01:51:09.680 --> 01:51:15.260 position:50% align:middle If you click that, you'll then see a long list of different tests and things like that 01:51:15.260 --> 01:51:17.010 position:50% align:middle on the left-hand side. 01:51:17.010 --> 01:51:23.280 position:50% align:middle And then once you find NGN project, there's a choice for NGN resources. 01:51:23.280 --> 01:51:24.370 position:50% align:middle I know it's a lot of clicks. 01:51:24.370 --> 01:51:29.710 position:50% align:middle But the point is, when you click NGN Resources, the newsletters are literally like the very top 01:51:29.710 --> 01:51:32.220 position:50% align:middle of the page. 01:51:32.220 --> 01:51:33.850 position:50% align:middle But here's what I do. 01:51:33.850 --> 01:51:37.300 position:50% align:middle If you were to do a Google search, and you just put NGN newsletter, 01:51:37.300 --> 01:51:41.450 position:50% align:middle it literally...your first result would be the page with all the newsletters. 01:51:41.450 --> 01:51:42.130 position:50% align:middle So that's awesome. 01:51:42.130 --> 01:51:44.450 position:50% align:middle That's how I get there the fastest. 01:51:44.450 --> 01:51:47.200 position:50% align:middle We are number one in the search results. 01:51:47.200 --> 01:51:48.590 position:50% align:middle Okay. 01:51:48.590 --> 01:51:52.640 position:50% align:middle Where will I find the link to the presentation? 01:51:52.640 --> 01:51:55.260 position:50% align:middle I think...okay Anita has already answered that. 01:51:55.260 --> 01:51:55.720 position:50% align:middle Wonderful. 01:51:55.720 --> 01:51:56.920 position:50% align:middle Thank you, Anita. 01:51:56.920 --> 01:52:00.000 position:50% align:middle Oh, and a direct link from Kathy to the newsletters. 01:52:00.000 --> 01:52:01.570 position:50% align:middle Thank you. 01:52:01.570 --> 01:52:05.880 position:50% align:middle Scoring for the cloze items like the pull-down menu items. 01:52:05.880 --> 01:52:08.140 position:50% align:middle Honestly, it depends a little bit. 01:52:08.140 --> 01:52:10.690 position:50% align:middle Our scoring newsletter gives several examples. 01:52:10.690 --> 01:52:19.080 position:50% align:middle So I would encourage that if the menus are connected by a because then it's almost always rationale scoring, 01:52:19.080 --> 01:52:21.090 position:50% align:middle right, because the pieces go together. 01:52:21.090 --> 01:52:25.630 position:50% align:middle If it's more like, the nurse should be interested in this thing about the client, 01:52:25.630 --> 01:52:29.790 position:50% align:middle and also this thing about the client, well, those might be scored separately. 01:52:29.790 --> 01:52:36.050 position:50% align:middle And in that case, those would be scored as 0/1 for each menu, right? 01:52:36.050 --> 01:52:41.430 position:50% align:middle You would just get a score for the first menu right or wrong, and a score for the second menu, right or wrong. 01:52:41.430 --> 01:52:46.450 position:50% align:middle So with close items or pull-down menu items, there can be some variety in the scoring. 01:52:46.450 --> 01:52:51.000 position:50% align:middle The newsletter goes into a little more detail. 01:52:51.000 --> 01:52:53.600 position:50% align:middle All right. 01:52:53.600 --> 01:52:54.260 position:50% align:middle Oh, thank you. 01:52:54.260 --> 01:52:55.870 position:50% align:middle Thank you, Veronica. 01:52:55.870 --> 01:52:57.560 position:50% align:middle From Angelica. 01:52:57.560 --> 01:53:05.830 position:50% align:middle Do the scenario questions ever include patient race, or religion, from a cultural competence perspective? 01:53:05.830 --> 01:53:12.650 position:50% align:middle And I would say in that case, if relevant to the questions that follow. 01:53:12.650 --> 01:53:19.220 position:50% align:middle So the one I showed, or even the two I showed, I believe none of that information was included. 01:53:19.220 --> 01:53:24.480 position:50% align:middle Fairly typical of traditional NCLEX items to include almost as little information as possible, 01:53:24.480 --> 01:53:27.210 position:50% align:middle I suppose, about who the client is. 01:53:27.210 --> 01:53:35.220 position:50% align:middle But yeah, if important to the questions or the keys, then certainly included. 01:53:35.220 --> 01:53:37.710 position:50% align:middle Mary hyping our mailing list, I appreciate it. 01:53:37.710 --> 01:53:41.534 position:50% align:middle Yes, if you're on our mailing list, you will get those newsletters 01:53:41.534 --> 01:53:43.550 position:50% align:middle the minute they come out. 01:53:43.550 --> 01:53:44.490 position:50% align:middle Linda with a thank you. 01:53:44.490 --> 01:53:45.180 position:50% align:middle I appreciate it. 01:53:45.180 --> 01:53:46.560 position:50% align:middle Valerie also. 01:53:46.560 --> 01:53:48.330 position:50% align:middle Andretta also. 01:53:48.330 --> 01:53:51.060 position:50% align:middle Ann also, Deborah, also. 01:53:51.060 --> 01:53:52.260 position:50% align:middle Gina also. 01:53:52.260 --> 01:53:54.260 position:50% align:middle Carol says terrible presentation. 01:53:54.260 --> 01:53:55.120 position:50% align:middle No, I'm teasing. 01:53:55.120 --> 01:53:56.730 position:50% align:middle I made that up. 01:53:56.730 --> 01:53:57.970 position:50% align:middle Erin, thank you. 01:53:57.970 --> 01:54:00.000 position:50% align:middle Well, let's do this. 01:54:00.450 --> 01:54:04.260 position:50% align:middle We still have two minutes to spare and I still have a little bit of a voice. 01:54:04.260 --> 01:54:05.820 position:50% align:middle I don't want to leave out our organizers. 01:54:05.820 --> 01:54:08.820 position:50% align:middle Let me just say it was such a pleasure. 01:54:08.820 --> 01:54:10.530 position:50% align:middle I wish you all the best success. 01:54:10.530 --> 01:54:16.390 position:50% align:middle I am available to come back and do this again, anytime even my half-day Action Model Workshop. 01:54:16.390 --> 01:54:17.640 position:50% align:middle Oh boy. 01:54:17.640 --> 01:54:18.770 position:50% align:middle So thank you. 01:54:18.770 --> 01:54:20.400 position:50% align:middle Such great questions. 01:54:20.400 --> 01:54:27.530 position:50% align:middle And I suppose let me turn it back over maybe to Jasmine if that's the right place to take it. 01:54:27.530 --> 01:54:31.990 position:50% align:middle - Or I can take it unless Jasmine, did you have anything to say? 01:54:31.990 --> 01:54:32.980 position:50% align:middle - [Jasmine] No. 01:54:32.980 --> 01:54:35.080 position:50% align:middle Win, you can close this out for the day. 01:54:35.080 --> 01:54:40.070 position:50% align:middle - Okay, Jason, Jason, that was just so informative. 01:54:40.070 --> 01:54:44.470 position:50% align:middle And you are such a great presenter, very engaging. 01:54:44.470 --> 01:54:52.520 position:50% align:middle You have a fabulous voice, by the way, it helped me continue to pay attention, for sure. 01:54:52.520 --> 01:55:01.280 position:50% align:middle And I hope everybody who joined us today was able to gain important knowledge. 01:55:01.280 --> 01:55:09.520 position:50% align:middle So the National Council of State Boards of Nursing will be archiving this presentation on their website. 01:55:09.520 --> 01:55:15.410 position:50% align:middle And once we package it and get it over to NCSBN, and they get it on their website, 01:55:15.410 --> 01:55:21.990 position:50% align:middle we will also be sharing that link via our communications and via our website. 01:55:21.990 --> 01:55:26.160 position:50% align:middle So, if you missed anything, you will be able to access it. 01:55:26.160 --> 01:55:31.870 position:50% align:middle And we also encourage you to pass on the webinar to your colleagues. 01:55:31.870 --> 01:55:38.640 position:50% align:middle Also, we encourage you to follow the Campaign for Action on Twitter. 01:55:38.640 --> 01:55:46.620 position:50% align:middle Join us on Facebook and sign up for the bi-weekly campaign update, which is www.campaignforaction.org. 01:55:46.620 --> 01:55:51.670 position:50% align:middle That's how you can find out about other programs we have. 01:55:51.670 --> 01:55:56.890 position:50% align:middle So with that, I thank Jasmine for organizing this. 01:55:56.890 --> 01:56:08.870 position:50% align:middle Dr. Brunel Dinwiddie for helping us organize this, and several other folks who met with us with NCSBN a 01:56:08.870 --> 01:56:10.720 position:50% align:middle month or so ago. 01:56:10.720 --> 01:56:20.080 position:50% align:middle And I can't remember everybody who was there, but Dr. Tracy Merry, Dr. Adriana Perez, 01:56:20.080 --> 01:56:21.030 position:50% align:middle and several other people. 01:56:21.030 --> 01:56:22.000 position:50% align:middle So thank you, everybody.