Journal of Nursing Education

Major Article 

Laying a Foundation for Evaluating Curricular Performance: Tools of the Trade

Pamela E. Davis, MSN, RN, ANP, CPHQ; Sandra M. Grinnell, MSN, RN; Louise M. Niemer, PhD, RN

Abstract

A proactive and systematic approach to evaluating curriculum success supports the cost-effective use of student and organizational resources by contributing to improved student satisfaction, retention and graduation rates, and high pass rates on the NCLEX®—all measures of program quality. This article describes a process and tools for evaluation of baccalaureate prelicensure curricula using HESI standardized testing. The approach is both formative and summative and can be easily adapted for use with other standardized testing products. This evaluation method provides a vehicle to demonstrate achievement of program core concepts and role competencies to internal and external stakeholders, licensing agencies, and accrediting bodies. Curriculum committees are able to proactively evaluate rigor and identify opportunities for continuous improvement. The described process represents a key element of a more comprehensive framework for undergraduate nursing program evaluation. [J Nurs Educ. 2013;52(12):671–679.]

Ms. Davis is Assistant Professor, Ms. Grinnell is Associate Professor, and Dr. Niemer is Associate Professor, Department of Nursing, Northern Kentucky University, Highland Heights, Kentucky.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Megan Cowherd for her assistance with the development of the Figure and Tables. They also thank Leslie Nicoll, PhD, MBA, RN, Denise Robinson, PhD, RN, FNP, and Carrie McCoy, PhD, MSPH, RN, CEN, for their editorial assistance.

Address correspondence to Pamela E. Davis, MSN, RN, ANP, CPHQ, Assistant Professor, Department of Nursing, Northern Kentucky University, Albright Health Center #343, Nunn Drive, Highland Heights, KY 41099; e-mail: davisp3@nku.edu.

Received: April 06, 2013
Accepted: July 31, 2013
Posted Online: November 18, 2013

Abstract

A proactive and systematic approach to evaluating curriculum success supports the cost-effective use of student and organizational resources by contributing to improved student satisfaction, retention and graduation rates, and high pass rates on the NCLEX®—all measures of program quality. This article describes a process and tools for evaluation of baccalaureate prelicensure curricula using HESI standardized testing. The approach is both formative and summative and can be easily adapted for use with other standardized testing products. This evaluation method provides a vehicle to demonstrate achievement of program core concepts and role competencies to internal and external stakeholders, licensing agencies, and accrediting bodies. Curriculum committees are able to proactively evaluate rigor and identify opportunities for continuous improvement. The described process represents a key element of a more comprehensive framework for undergraduate nursing program evaluation. [J Nurs Educ. 2013;52(12):671–679.]

Ms. Davis is Assistant Professor, Ms. Grinnell is Associate Professor, and Dr. Niemer is Associate Professor, Department of Nursing, Northern Kentucky University, Highland Heights, Kentucky.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank Megan Cowherd for her assistance with the development of the Figure and Tables. They also thank Leslie Nicoll, PhD, MBA, RN, Denise Robinson, PhD, RN, FNP, and Carrie McCoy, PhD, MSPH, RN, CEN, for their editorial assistance.

Address correspondence to Pamela E. Davis, MSN, RN, ANP, CPHQ, Assistant Professor, Department of Nursing, Northern Kentucky University, Albright Health Center #343, Nunn Drive, Highland Heights, KY 41099; e-mail: davisp3@nku.edu.

Received: April 06, 2013
Accepted: July 31, 2013
Posted Online: November 18, 2013

As demand continues to grow for higher levels of knowledge, skill, and ability in entry-level RNs, regulatory agencies and accrediting bodies continue to raise the bar in setting minimum standards for safe and effective practice. In April 2013, the National Council of State Boards of Nursing (NCSBN) increased the passing standard for the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) with the implementation of the 2013 NCLEX-RN Test Plan (NCSBN, 2013c). Both the Accreditation Commission for Education in Nursing (ACEN) and the Commission on Collegiate Nursing Education (CCNE) identify performance on licensure examination as a criterion for assessing achievement of program outcomes (ACEN, 2013; CCNE, 2009). Morrison (2005) and Harding (2010) reported that following the implementation of increased passing standards by the NCSBN, U.S. nursing programs experienced a drop in NCLEX-RN pass rates. Low pass rates may have serious adverse effects on a program’s continued accreditation, approval, funding, reputation, and ability to recruit potential students (Harding, 2010). Programs that have been successful in raising their pass rates are likely to credit improved methods of evaluation as one means to their success (Morrison, 2005).

The NCSBN reviews the NCLEX-RN Test Plan every 3 years to ensure that the content and behaviors tested reflect priority areas in current entry-level nursing practice. Content areas in the NCLEX-RN Test Plan are organized into four major client needs categories. The 2013 test plan places more emphasis on provision of a Safe and Effective Care Environment and less emphasis on Physiological Integrity than the 2010 test plan (NCSBN, 2013a). Changes in test plan content create challenges for baccalaureate nursing (BSN) programs in ensuring their curricula continue to meet or exceed standards for rigor and desired program outcomes.

In light of the ongoing changes in professional standards and competencies required to prepare graduates to be successful in the current practice environment, it is vital that baccalaureate nursing programs develop a strong foundation for curricular evaluation and measure performance on the NCLEX-RN as a key indicator of program effectiveness. In 2009, after experiencing a declining trend in NCLEX-RN scores, Northern Kentucky University began a change process that included a redesign of its undergraduate prelicensure nursing curriculum (traditional BSN and accelerated BSN [ABSN] programs) and the purchase and integration of a curricular support and testing program, Health Education Systems, Inc. (HESI), through Elsevier in St. Louis, Missouri. The program evaluation committee was charged with developing a framework, standards, and measures for evaluating curricular performance during the transition to the new curriculum.

The value of HESI testing as an element of curricular evaluation has been documented in the literature (Morrison, 2005; Schroeder, 2013). The authors of the current article believe it is unique, however, in offering a detailed process and tools for formative and summative evaluation of baccalaureate prelicensure curriculum effectiveness using HESI standardized testing. Curricular evaluation represents one key element in a comprehensive program evaluation plan.

Organizing Framework for Evaluation

Evaluation is a cyclic, ongoing process and must be implemented through a systematic program (Billings & Halstead, 2009). It serves the purpose of clearly demonstrating how the program meets quality standards established by governance, regulatory, and accrediting bodies (Escallier & Fullerton, 2012). Several conceptual frameworks appropriate for organizing program evaluation in nursing education are discussed in the literature (Billings & Hallstead, 2009; Escallier & Fullerton, 2012; Keating, 2011; Oermann & Gaberson, 2009). The context, input, process, and product (CIPP) educational model (Stufflebeam, Madaus, & Kellaghan, 2000) was selected as the organizing framework for evaluation of the baccalaureate program at Northern Kentucky University. A continuous quality improvement model was also used to incorporate target measures for benchmarking performance.

CIPP Model

The CIPP model is a decision-oriented design that emphasizes both proactive evaluation for program improvement and retroactive evaluation to assess program quality. It adapts easily to incorporate various formats and standards developed by accrediting organizations. The context component evaluates the degree to which the program supports the mission and goals of the organization and the needs of key stakeholders (Billings & Halstead, 2009; Suhayda & Miller, 2006). Input evaluation assesses the institutional commitment for providing the human, physical, and financial resources needed to sustain the program. Process evaluation examines design and implementation of the curriculum. Product evaluation provides an assessment of the satisfaction, performance, and accomplishments of faculty and students (Suhayda & Miller, 2006).

Quality Improvement Model

Benchmarking is a process improvement technique used in quality improvement models to compare a nursing program’s performance on selected measures with similar institutions that are recognized for excellence in education or against industry standards. Benchmarking provides factual data that promote continuous improvement to achieve a higher level of performance (Billings & Halstead, 2009).

Program Evaluation Plan

In 2009, Northern Kentucky University completed an initial program evaluation plan. Criteria assessing curriculum performance were documented under the Process component of the CIPP model. Curricular standards from accrediting bodies were incorporated into the criteria, which are as follows: (a) the curriculum prepares students to achieve the outcomes of the nursing education unit including safe practice; (b) the curriculum is developed by faculty and regularly reviewed for rigor and currency; (c) the curriculum reflects professional nursing standards, best practices, and the needs and expectations of the community; and (d) practice learning environments are appropriate for student learning and support the achievement of student learning and program outcomes. For each criterion, data sources, measures, achievement targets, assignment of responsibility, and frequency of review were incorporated into a matrix that provides structure for the evaluation process (Suhayda & Miller, 2006).

The program evaluation plan provided both formative and summative measures of curriculum effectiveness. The primary data source used for formative evaluation, defined as evaluation taking place during the learning process (Billings & Halstead, 2009), was standardized testing through HESI. The administration of HESI examinations at selected points throughout the curriculum provided an opportunity to identify student and curricular weaknesses so actions could be taken proactively to improve educational outcomes (Morrison, 2005). Summative evaluation refers to data collected at the culmination of an educational program and provides a measure of overall program quality (Billings & Halstead, 2009). Sources of data for summative evaluation included HESI standardized testing and NCLEX-RN pass rates, as obtained from state boards of nursing.

Achievement targets were established for HESI test scores based on predictive value in achieving a passing NCLEX-RN score and alignment with progression policies established after the initiation of the curricular support and testing program. Administering nationally normed, reliable, and valid examinations throughout the curriculum provides a proactive method for assessing and benchmarking student performance (Morrison, 2005).

Governance Structure

According to Gard, Flannigan, and Cluskey (2004), “Having a standing committee with key oversight for the evaluation process is an effective mechanism for program evaluation” (p. 176). The Department of Nursing at Northern Kentucky University has four standing committees: (a) program, (b) admission, progression, and graduation, (c) curriculum, and (d) program evaluation. Representation on the program evaluation committee includes a chairperson, two program directors (one BSN and one ABSN), and at least one faculty member from each standing committee. The department chair serves in an ex officio capacity. The committee is responsible for: (a) development, implementation, and revision of the program evaluation plan; (b) recommending data collection instruments and procedures relating to program evaluation; (c) data collection and analysis; and (d) reporting findings to the department chair and program committee to facilitate program improvement. The program committee comprises all department of nursing faculty under the leadership of the department chair.

Under this governing structure, a clear process exists for communicating curricular trends and outcomes to faculty and department leaders. Performance on key measures is communicated, recommendations are shared, and the appropriate standing committee assumes responsibility for further investigation and action planning when indicated. The program evaluation committee receives action plans and monitors and communicates progress in achieving targeted performance. Suhayda and Miller (2006) provided templates for program evaluation committees to document and monitor progress in achieving recommended changes.

Data Collection

Source

Although other sources of data were utilized in evaluating curriculum effectiveness in the department of nursing (e.g., student evaluation of courses, clinical faculty and facilities, and programs), the current article focuses on the role of standardized testing as a measure of curricular quality.

Measurement tools should be obtained from sound, scientifically developed instruments (Morrison, 2005). The computerized specialty and exit examinations developed by HESI provide a high degree of reliability and validity in assessing students’ progress through the nursing program and their preparedness for the licensing examination (Langford &Young, 2013; Lavandera et al., 2011; Morrison, Adamson, Nibert, & Hsia, 2004). Morrison et al. (2004) described the methods used to establish reliability and validity of these products.

HESI offers a variety of testing options for curricular evaluation. Specialty examinations measure proficiency in specific content areas, such as fundamentals, medical–surgical, pharmacology, and management. Custom examinations, such as the midcurricular examination, utilize a test blueprint based on a program’s course outlines for the first half of the curriculum. The exit examination is designed to be administered near the completion of the curriculum to assess readiness for the NCLEX-RN. Different versions of the examinations are available and provide value in evaluating the impact of remediation efforts (Morrison, 2005; Morrison et al., 2004).

Students’ total scores and subject area scores on the examinations are reported as HESI scores and are calculated using a proprietary mathematical model that has been applied to the raw data. The HESI scores are based on individual weighting of each test item answered correctly, and they can be used to predict the likelihood of NCLEX-RN success. HESI exit and specialty examinations also reflect results in the form of a conversion score. This score is based on the average weight of all test items answered correctly and can be used as a component of a student’s final course grade (Morrison, 2005).

For purposes of program evaluation, the department of nursing used the fundamentals, midcurricular, and exit examinations to gauge academic progress throughout the curriculum, which spanned six semesters for BSN programs and four semesters for ABSN programs. Several specialty examinations were integrated into course requirements (medical–surgical, pharmacology, and management), and conversion scores were used to develop the course grade.

Organization

Two versions of the fundamentals examination were given to students. The program evaluation committee selected version two for data reporting, as version one was given midway into the first nursing semester when students had not completed all content included on this examination. Version 2 was given in nursing semester two, after the relevant course content was completed.

Two versions of the midcurricular examination were offered to BSN and ABSN students at the midpoint of their respective programs. Students scoring less than 850 on version 1 were enrolled in a one credit–hour remediation course and were retested upon course completion to gauge improvement. Students who were not successful in achieving the benchmark score utilized online support tools and progressed to semester four. The program evaluation committee selected version 1 for data reporting because it assessed curricular performance before remediation.

The exit examination was administered to students in the final semester of the program. Students scoring less than 900 were enrolled in a one-credit–hour remediation course and were offered two additional opportunities to take the examination to achieve the target measure of 900. Successful performance on the examination is a requirement for completion of the Role Transition course and graduation. The program evaluation committee selected version 1 for data reporting. The Figure depicts the curricular evaluation process and sequencing of HESI data collection and remediation support.

Process for curricular evaluation of baccalaureate prelicensure nursing program using HESI standardized testing. Note. CIPP = context, input, process, and product educational model; QI = quality improvement.

Figure.

Process for curricular evaluation of baccalaureate prelicensure nursing program using HESI standardized testing. Note. CIPP = context, input, process, and product educational model; QI = quality improvement.

Results of testing are reflected through HESI summary reports. Examination questions are categorized and presented in a variety of formats, including elements of the nursing process, client needs (based on the NCLEX-RN test plan), specialty and subspecialty area, ACEN accreditation categories, American Association of Colleges of Nursing (AACN) curriculum categories, Quality and Safety Education in Nursing categories, and nursing concepts. Mean HESI scores and conversion scores for the testing cohort are reflected for each test type (fundamentals, midcurricular, and exit). Mean HESI scores are also reported by category and subcategory. The total number of test items in a given category is documented. HESI also reports results, in the form of conversion scores, by specialty area and topic (e.g., fundamentals–basic nursing skills/hygiene–hand washing) and compares program and national results.

The program evaluation committee selected the 2008 AACN curriculum categories reporting format, upon approval of faculty, to trend performance on the curricular concepts necessary to support successful entry-level nursing practice. The committee developed a crosswalk document (Table 1), which aligned prelicensure program core concepts and the 12 AACN curriculum categories through linkages with the AACN’s Essentials of Baccalaureate Education for Professional Nursing Practice (2008). To demonstrate, the concept of professionalism was defined at the program level, compared with the definition provided in the AACN Essentials document, and linked to AACN Essential VIII: Professionalism and Professional Values. AACN curriculum categories that measured elements of this core concept were identified and included (a) professionalism and professional values and (b) member of a profession.

Department of Nursing (DON) Core Concepts and 2008 American Association of Colleges of Nursing (AACN) Curriculum Categories Crosswalk

Table 1:

Department of Nursing (DON) Core Concepts and 2008 American Association of Colleges of Nursing (AACN) Curriculum Categories Crosswalk

The department of nursing Core Concepts and 2008 AACN Curriculum Categories Crosswalk demonstrated the alignment of program core concepts with essential curricular elements, as described by the AACN, and provided a methodology for the development of a quantitative measure of student achievement relating to program core concepts. It also offered a framework for reporting and reflected target measures for achievement of competency in each core concept.

HESI summary test results were reported based on program type (BSN and ABSN) and test type (fundamentals, midcurricular, and exit). Performance trends of individual cohorts as they progress through the curriculum can be grouped based on the type and timing of the examination.

Frequency

Computer-based testing occurred throughout the academic year. Students received immediate feedback regarding their scores and overall performance and were provided with individualized online remediation support. HESI summary reports were made available to faculty within a week of test administration and were placed on a shared department network drive for ease of access. Targeted report data for program evaluation were collected and organized into standard formats by members of the program evaluation committee at the end of each semester.

Data Reporting and Analysis

Reporting Formats

Three standard reports were developed for documenting and trending curricular performance as measured through standardized testing. Table 2 provides a format for trending mean HESI scores for each of the 2008 AACN curriculum categories. It is organized by program type, examination type, and semester. The number of students in each testing cohort is also identified. Prior to spring 2011, two versions of the exit examination were administered; students were required to take both versions before remediation was offered. The program evaluation committee selected version 2 for reporting because many students, aware they would be required to take the version 2, took the version 1 with minimal preparation. A later change in testing policy removed the requirement to take the version 2 examination if the student achieved the targeted benchmark score on version 1. The policy was revised, and the program evaluation committee began documenting the version 1 score on the exit test. This change is reflected in the formatting of the report and informs the analysis of changes in testing outcomes.

HESI Exit Test Trend Report Using 2008 AACN Curriculum Categories in a Traditional BSN Program

Table 2:

HESI Exit Test Trend Report Using 2008 AACN Curriculum Categories in a Traditional BSN Program

As indicated previously, the department of nursing implemented a new curriculum in fall 2010. Testing cohorts in the legacy curriculum were identified by a special character (b) in the table column heading. Shading of column headings provided another option to facilitate comparison of data for cohorts in the legacy versus the new curriculum.

Two reports address department of nursing core concepts. The first report is displayed in Table 3 and was developed based on the core concept crosswalk document in Table 1. It depicts performance on each core concept and its associated AACN curriculum categories for fundamentals, midcurricular, and exit tests administered in a given semester. The score for each core concept represents the mean combined HESI score for all related AACN categories. Using the core concept of Cultural Sensitivity as an example, the mean score of 963 on the exit version 1 test was derived from adding the scores for AACN categories two (liberal education for BSN generalist) and four (BSN generalist nursing practice) and dividing by 2—the number of associated AACN categories (960 + 965 ÷ 2 = 963). Benchmark scores were established for performance on core concepts and AACN curriculum categories.

HESI Test Scores Within 2008 AACN Curriculum Categories and DON Core Concepts in a Traditional BSN Program, Fall 2012

Table 3:

HESI Test Scores Within 2008 AACN Curriculum Categories and DON Core Concepts in a Traditional BSN Program, Fall 2012

A second report, as shown in Table 4, trends the mean HESI scores for core concepts from semester to semester. This report is also specific to program and test type. The core concept reports were developed and implemented in spring 2011 and reflect a shorter trending period than the report in Table 2.

DON Core Concept Trend Report for HESI Exit Test Version 1 in a Traditional BSN Programa

Table 4:

DON Core Concept Trend Report for HESI Exit Test Version 1 in a Traditional BSN Program

Data Integrity and Limitations

Several factors, independent of individual student attributes, should be considered when evaluating test scores. The first issue relates to the number of test items delivered in a given report category. To demonstrate, of the twelve 2008 AACN curriculum categories that appear in each HESI Summary Report, three categories (professionalism and professional values [5], health care policy [9], and member of a profession [11]) had two or fewer test items for one or more test types. Review of trending reports reflected greater variation in test scores for these categories. A notation was made on the appropriate report type to inform those conducting data analysis. HESI exit tests have consistently provided a sufficient number of items in each of the categories to assess performance on all AACN indicators.

The HESI midcurricular examination is customized. A test blueprint is developed based on the course outlines for the first half of a nursing program’s curriculum (Morrison, 2005). It is important that the program’s curriculum align with the current NCLEX-RN test plan for the results of the midcurricular test to reflect student achievement of key learning outcomes expected at this stage of progression. Programs in the process of transitioning to a new curriculum must evaluate changes in content between the two curricula at this stage and ensure a new testing blueprint is developed that reflects these changes. As the department of nursing trended data through a period of curricular change, reports identified testing cohorts in legacy versus new curricula to document this potential source of variation in scores.

Changes in testing policies may also affect student performance. As indicated previously, in spring 2011 the department revised a policy that required students to complete two versions of the exit examination. Improvement in overall performance was noted after the policy was revised to accept a version 1 score that met or exceeded the performance benchmark. Table 2 reflects the overall improvement in AACN curriculum category scores from fall 2010 to spring 2011. A notation in the report reflects the timing and details of the policy change.

Facilitating Issue Identification Through Reporting

HESI summary reports compare school and national results for each test question based on specialty area and topic (i.e., Medical–Surgical–Endocrine–Diabetes–acute confusion). This provides an opportunity for program evaluation and curriculum committees to drill down and obtain more detail regarding content areas that may require additional focus. It also facilitates benchmarking against national data to gauge performance. Utilizing this report feature with fundamentals and midcurricular test types supports the development of proactive strategies to address curricular gaps.

The department purchased a subscription to another reporting resource offered through the NCSBN. The reporting package ranks a program’s performance in each of the eight areas of the NCLEX-RN Test Plan and in six content dimensions. Program results are compared with others regionally and nationally during a 6-month period. Results in the current period are compared with those of the previous period (NCSBN, 2013b). Comparing results of student performance on both the HESI and NCSBN reports can provide a good foundation for further exploration of strengths and weakness in the curriculum.

Using Findings for Program Improvement

For evaluation to be most effective, the organization must embrace a culture that supports data-driven decisions with the goal of continuous quality improvement (Suhayda & Miller, 2006). Although the primary responsibility for curricular evaluation rests with the program evaluation and curriculum committees, engaging faculty in the evaluation process through regular data sharing facilitates understanding of the impact of program changes on academic performance and fosters involvement in problem solving and action planning directed at improving program quality (Escallier & Fullerton, 2012). Documentation and communication of progress on action plans provides a critical feedback loop between faculty and the program evaluation committee to gauge improvement in the teaching–learning process (Gard et al., 2004). It also provides licensing and accrediting agencies with a resource for validation of process improvement.

Results of data analysis should also be regularly communicated to program administrators and other key stakeholders. Annual program-level reporting may be required within the academic institution to monitor progress in strategic planning and maintain regional accreditation. Program data and demographics may also be required from state boards of nursing and accrediting agencies (Gard et al., 2004). The department of nursing advisory board is an example of an external stakeholder group that receives summary program evaluation data and contributes feedback regarding issues relating to curricular rigor and currency.

The nursing department has achieved consistent improvement in HESI scores for all test types after implementing the process of curriculum evaluation outlined previously. The data reflect that changes in the curriculum, progression policies, and timely remediation support for at-risk students had a positive impact on academic performance. Although the first class in the new curriculum graduated in spring 2013, trending of performance on fundamentals and midcurricular examinations is sufficient to begin to identify and address curricular gaps.

As undergraduate nursing programs adopt progression policies that include successful performance on standardized testing, it is important to address the need for both a proactive and systematic process for evaluating curricular effectiveness and early identification of at-risk students (Harding, 2010; Spurlock, 2006). This approach supports the cost-effective use of student and organizational resources by contributing to improved student satisfaction, retention and graduation rates, and successful completion of the state licensure examination. Performance on these measures influences the perception of consumers, employers, licensing and accrediting bodies, and other stakeholders when making decisions relating to program quality.

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Department of Nursing (DON) Core Concepts and 2008 American Association of Colleges of Nursing (AACN) Curriculum Categories Crosswalk

DON Core ConceptAACN Curriculum CategoryaDON Core Concept DefinitionAACN Curriculum Category Definitiona
Role competenceClinical prevention and population health (6); leadership for quality care and patient safety (7); information management and patient care technology (8); health care policy (9); designer/manager/coordinator of care (10); member of a profession (11); provider of care (12)Accurate application of specialized nursing knowledge, values, and skills necessary to provide care to people in myriad settings.Baccalaureate graduates are prepared to gather and document care data that serve as a foundation for decision making for the health care team (Essential V). Health promotion, disease, and injury prevention across the lifespan are essential elements of baccalaureate nursing practice at the individual and population levels (Essential VII).
CaringProfessionalism and professional values (5); health care policy (9)An action and ideal that reflects the valuing of others and is manifested in the nurse’s commitment to concern of self and others.Advocacy for vulnerable populations with the goal of promoting social justice is recognized as a moral and ethical responsibility of the nurse (Essential V). Caring is a concept central to professional nursing practice. Ethics is an integral part of nursing practice (Essential VIII).
ProfessionalismProfessionalism and professional values (5); member of a profession (11)A commitment to following core values, ethics, values, and standards of nursing, including community service, leadership, accountability, responsibility, and lifelong learning.Professionalism is defined as the consistent demonstration of core values evidenced by nurses working with other professionals to achieve optimal health and wellness outcomes in patients, families, and communities by wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability (Essential VIII).
CommunicationInterprofessional communication (3); leadership for quality care and patient safety (7); information management and patient care technology (8)The dynamic, purposeful, and skillful exchange of facts, information, ideas, attitudes, and feelings through written, verbal, nonverbal, and electronic means. Therapeutic communication results in movement toward goals that are consistent with desired health outcomes.Interprofessional education enables the baccalaureate graduate to enter the workplace with baseline competencies and confidence for interactions and with communication skills that will improve practice, thus yielding better patient outcomes (Essentials IV, VI).
Critical thinkingLiberal education for BSN generalist (2); BSN generalist nursing practice (4); leadership for quality care and patient safety (7)A process that includes questioning, analysis, interpretation, inferences, and synthesis that informs independent and interdependent nursing practice.The baccalaureate graduate demonstrates clinical reasoning within the context of patient centered care to form the basis for nursing practice that reflects ethical values. Professional nursing requires strong critical reasoning, clinical judgment, communication, and assessment skills (Essential I).
Cultural sensitivityLiberal education for BSN generalist (2); BSN generalist nursing practice (4)An ongoing process of recognizing, accepting, and respecting different world views. It is evidenced in the informed interaction with others.The increasing globalization of health care requires that professional nurses be prepared to practice in a multicultural environment and possess the skills needed to provide culturally competent care (Essential IX).
Research/evidence-based practiceScholarship for evidence-based practice (1); leadership for quality care and patient safety (7); liberal education for BSN generalist (2); information management and patient care technology (8)Research is systematic inquiry for the purpose of generating new knowledge. Evidence-based practice is the evaluation of existing knowledge for its utility to nursing.Professional nursing practice is grounded in the translation of current evidence into practice. Baccalaureate graduates will be able to recognize quality concerns and apply evidence based knowledge from the nursing profession and other clinical sciences to their practice (Essentials II, III).

HESI Exit Test Trend Report Using 2008 AACN Curriculum Categories in a Traditional BSN Program

Version 2 ScoreVersion 1a Score


Spring 2010bFall 2010bSpring 2011bFall 2011bSpring 2012Fall 2012
Scholarship for evidence-based practice774747808866938964
Liberal education for BSN generalist786775835875938965
Interprofessional communications680834930922881937
BSN generalist nursing practice787776837872937960
Professionalism and professional values862858764874904856
Clinical prevention and population health780751839884947980
Leadership for quality and patient safety794785831829911940
Information management and patient care technology7466219959489341,000
Health care policy786807801926913960
Designer/manager/coordinator of care7967847939199411,012
Member of profession779835633932-1,028
Provider of care789771835864935969
Students (n)775056544942

HESI Test Scores Within 2008 AACN Curriculum Categories and DON Core Concepts in a Traditional BSN Program, Fall 2012

AACN Curriculum Category and DON Core ConceptaMean Test Score

Fundamentals, Version 2aMidcurricularaExit, Version 1
Clinical prevention and population health (6)924865980
Leadership for quality and patient safety (7)864820943
Information management and patient care technology (8)7667361000
Health care policy (9)873797960
Designer/manager/coordinator of care (10)8926971012
Member of a profession (11)8019001028
Provider of care (12)901851969
DON role competence (average of AACN categories)860809985
Professionalism and professional values (5)702867856
Health care policy (9)873797960
DON professionalism (average of AACN categories)788832908
Professionalism and professional values (5)702867856
Member of a profession (11)8019001028
DON caring (average of AACN categories)752884942
Inter-professional communication (3)869785937
Leadership for quality and patient safety (7)864820943
Information management and patient care technology (8)7667361000
DON communication (average of AACN categories)833780960
Liberal education for BSN generalist (2)905848965
BSN generalist nursing practice (4)905848960
Leadership for quality and patient safety (7)864820943
DON critical thinking (average of AACN categories)891839956
Liberal education for BSN generalist (2)905848965
BSN generalist nursing practice (4)905848960
DON cultural sensitivity (average of AACN categories)905848963
Scholarship for evidence-based practice (1)897892964
Leadership for quality and patient safety (7)864820943
Liberal education for BSN generalist (2)905848965
Information management and patient care technology (8)7667361000
DON research/evidence-based practice (average of AACN categories)858824968

DON Core Concept Trend Report for HESI Exit Test Version 1 in a Traditional BSN Programa

DON Core ConceptMean Test Score
Spring 2011Fall 2011Spring 2012Fall 2012
Role competence807900930985
Caring783900909908
Professionalism699903904942
Communication919900909960
Critical thinking834859929956
Cultural sensitivity836874938963
Research/evidence-based practice867880930968
Students (n)56544942

10.3928/01484834-20131118-03

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