Critical Thinking Paper 1C: Rubric Design. Gina Gessner. Georgetown University

Transcription

1 Running Head: Critical Thinking 1C 1 Critical Thinking Paper 1C: Rubric Design Gina Gessner Georgetown University

2 Critical Thinking Paper 1C 2 Essay exams are frequently used in higher education to allow students a vehicle for displaying relevant information in a comprehensive and ordered format (Brennan, 1995). The questions below are designed are for students enrolled in an undergraduate medical surgical nursing course. Course objectives include providing safe and effective care for adults in the medical surgical population. Also, upon completion of the course students should have a broad understanding of common medical-surgical complications and related treatment goals for this patient population. Students should also know risk factors and common co-morbidities of diseases and how these relate to nursing care and education of patients. Students in this course must have a thorough grasp on pathophysiology (a prerequisite) and how it relates to the nursing care of adults. Students in this course must also have prior knowledge in nutrition (a prerequisite) and be able to utilize background knowledge and apply it appropriately in the clinical setting. A grading rubric for the essay was devised for several reasons. Firstly, it is important for students and teachers to have a clear understanding of what is required from the essay. A study by Norton (1990) found that teachers were most concerned with structure and argument while students focused mostly on presentation and providing an answer to the essay question. Thus, by clearly delineating what is required from an essay, the risk for confusion is reduced. Secondly, if used correctly, a rubric can serve as a teaching as well as an evaluative tool (Andrade, 1997). A properly designed rubric gives students clear example of high quality work as well as poor work. When a rubric includes a description scale for a corresponding letter grade, the student can comprehend why the received the grade and how they can improve future performance (Moskal, 2000).

3 Critical Thinking Paper 1C 3 An analytic rubric was chosen due to the fact that conceptual understanding and critical thinking skills would be assessed. This type of rubric would also allow for the assessor to provide detailed feedback for the students regarding their performance (Billings & Halstead, 2009). The rubric will list a criterion and exhibit varying degrees of quality to which the students work will be assigned. By including a descriptive statement in the rubric, interrater reliability is increased (Moskal, 2000). An analytic rubric also has the benefit of eliminating overly harsh penalties when assigning a grade (Moskal, 2000). A benefit of using a rubric to grade essays is its flexible quality. The instruction can tailor the rubric to more heavily weight different evaluative aspects (Moskal, 2000). Additionally, by developing a pre-defined scheme for the evaluation process, the subjectivity involved in evaluating an essay becomes more objective (Moskal, 2000, p. ). Rubrics used in higher education are commonly theory based, utilizing Benner s novice to expert or Bloom s cognitive domains (Gantt, 2010). The A level work will most closely resemble the higher levels of cognitive domain in Bloom s Taxonomy, evaluation, synthesis and analysis. The rubric also touches on the affective domain, in regards to valuing and respecting all persons which is particularly important in nursing ( Elements in the rubric regarding grammar, APA format and the appropriate use of sources were included to help refine students abilities to create a professional paper. The questions for the students require the student to utilize critical thinking skills by utilizing background knowledge of pathophysiology, synthesizing that information with med-surg nursing and nutrition to communicate appropriately with patients. The rubric places heavy emphasis on integration of knowledge encouraging a well conceptualized response. Questions

4 Critical Thinking Paper 1C 4 #1. Jill Stewart is a 34yo female newly diagnosed with obstructive sleep apnea related to her large neck circumference and BMI of 34, which classifies her as obese. Jill states, I don t want to wear my CPAP machine, isn t there anything else I can do? You explain to Jill that her sleep apnea could be attributed to her obesity. Jill is shocked and wants to know, if there is anything else obesity can cause? Please explain how obesity can be attributed to health complications in the medical-surgical population in multiple organ systems, including cardiovascular, respiratory, endocrine and an additional system of your choosing. Please explain to Jill how these conditions are managed in the clinical setting and describe appropriate nursing interventions for each. Answer: CV: Obesity can increase risk of heart attack, stroke. Obesity causes increase in systemic blood flow as well as increases cardiac output. The obese individual is more at risk for atherosclerotic vascular changes which increase risk for MI and stroke. Adipose tissue secretes estrogen which increases risks of blood clots. Hypertension and high lipid levels can be caused by a poor diet. Hypertension is also caused by excess weight. It is also likely that an obese person will have high cholesterol and coronary artery disease which are linked to a poor diet. The conditions are very serious and require a high level of medical and nursing care. The nurse should educate the person regarding dietary changes (low salt, low fat), weight reduction, the importance of medication compliance (antihypertensives, statins). The nurse should also screen patients in the primary and acute care setting. Respiratory: Excess adipose tissue can reduce the amount of lung expansion and result in poor ventilation. Also, excessive tissue around the neck can compress upper airway structures resulting in apnea while sleeping. The nurse should screen patients for OSA in the

5 Critical Thinking Paper 1C 5 inpatient setting to reduce risk of apnea. The nurse can counsel patients on management options regarding CPAP masks, use or weight reduction. Endocrine: Metabolic syndrome is common in obese individuals. Adipose tissue is active metabolic tissue that can increase insulin resistance, which results in DM II. Prolonged high glucose levels due to diet can cause insulin resistance as well. The nurse should educate the patients regarding dietary changes, weight reduction, medication compliance. The nurse should educate these patients about potential complications from these conditions. Other: Student may mention musculoskeletal issues such as hernia, osteoarthritis, in which excess weight erodes connective tissue in knees, hips and other weight bearing joints. Gallstones are more common in obese individuals. Certain cancers grow from increased estrogen which is produced from adipose. Infertility is caused by obesity however this is not necessarily a med-surg concern. Other answers may be acceptable. 2. Obesity and weight loss teaching is an important role of the nurse although some find it difficult to discuss in the clinical setting due to sensitivity of the subject as well as it s time consuming nature. Please explain in detail how you would approach teaching Jill about her weight loss. Answer: Explain to Jill that a decrease in overall calories consumed will result in weight reduction. Explain to Jill that exercise is recommended to aid in weight loss as well beneficial to her cardiovascular system. Adding more fruits, vegetables and whole grains to her diet should also help in weight reduction as well as being beneficial to her overall health. Give the patient

6 Critical Thinking Paper 1C 6 resources such as support groups, ADA information, and weight loss organizations, such as weight watchers, etc. if she would like although this is not necessary. Consider using an interdisciplinary approach and utilize nutritionist for additional teaching. Students should elicit tact and professionalism in their communication with the patient. Rubric A to A- B to B- C to C- D and below Student exhibits high level critical thinking and responses are well conceptualized. Student justifies nursing interventions with pathophysiology, nutrition and medsurg nursing knowledge to provide a comprehensive response. Student thoroughly addresses all aspects of questions asked and supports ideas. Student displays evidence of holistic and respectful communication. Thoughts well organized in a logical sequence. APA format 6 th edition was used correctly. Spelling and grammar are correct. Appropriate use of sources provides support for statements made. Responses exhibit critical thinking. Nursing interventions are somewhat justified with pathophysiology, nutrition and medsurg knowledge. Nursing interventions are appropriate. Student addresses all aspects of questions. Student displays respectful communication. Thoughts organized and sequential. APA format 6 th edition was used with few errors found. Few spelling and grammatical errors. Sources are used, but may not be appropriate to support statements. Responses somewhat conceptualized and lack evidence of critical thinking. Student s interventions are lacking in prior knowledge of pathophysiology, nutrition and medsurg nursing. Student minimally addresses all aspects of questions. Communication techniques are somewhat compassionate and respectful. Writing somewhat disorganized and lacks flow. APA format 6 th edition was used with some errors found. Some spelling and grammatical errors. Sources are minimally used or not used appropriately. Responses poorly conceptualized and little critical thinking is evident. Prior knowledge in pathophysiology and nutrition is not integrated in response. Nursing interventions are absent or not appropriate. Some aspects of question remain unanswered and unsupported. Evidence of compassion and respect for the patient is lacking in responses. Writing is disorganized and difficult to follow. APA format 6 th edition was used very poorly or not at all. Many spelling and grammatical errors. Sources are lacking or not used appropriately to support ideas.

7 Critical Thinking Paper 1C 7 References Andrade, H. G. (1997) Understanding Rubrics. Educational Leadership, 54(4), Billings, D. M. & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty. Saunders Elsvier: St. Louis. Brennan, M. J. (1995) Essay writing in nursing: alerting students and teachers to the educational benefits. Nurse Education Today, 15 (5), Clark, D. R. (1999) Learning Domains of Bloom's Taxonomy. Retrieved from what Gantt, L. T. (2010). Using the Clark Simulation evaluation rubric with associate degree and baccalaureate nursing students. Nursing education perspectives, 31 (2), Moskal, B. M. (2000) Scoring rubrics: What, When and How? Practical assessment, research and evaluation, 7 (3). Norton L. S. (1990) Essay-writing: what really counts? Journal of Higher Education, 20, sayn L S 1 Andre G990 Essay-w

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