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NNAAP (National Nurse Aide Assessment Program): Job Analysis, Standard Setting and Next Steps Ada Woo, PhD Senior Psychometrician, NCSBN.

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Presentation on theme: "NNAAP (National Nurse Aide Assessment Program): Job Analysis, Standard Setting and Next Steps Ada Woo, PhD Senior Psychometrician, NCSBN."— Presentation transcript:

1 NNAAP (National Nurse Aide Assessment Program): Job Analysis, Standard Setting and Next Steps Ada Woo, PhD Senior Psychometrician, NCSBN

2 Outline Overview of test development process 2009 nurse aides job analysis 2010 NNAAP standard setting

3 NNAAP Test Development Process 1.Job Analysis 2.Content Outline 3.Item Writing and Item Review 4.Subject Matter Expert (SME) Panel Review 5.Editorial Review 6.Building Test Forms 7.Setting the Passing Standard 8.Pretesting of Items 9.Administering Examinations

4 Job Analysis Process Evidence of validity based on test content requires a thorough and explicit definition of the content domain of interest… characterization of the domain should be based on job analysis. (AERA, APA, NCME, Standards for Educational and Psychological Testing, 1999, p.160)

5 Background on Job Analysis Assist NCSBN in describing range of authorized duties and evaluating test plans. Provide validity evidence to support the examination. Conducted at least every five years. Large scale studies using multiple methods.

6 Methodology Document review Review of entry-level CNA daily logs Review of documents specific to CNA work settings Large scale surveys to NAEs and entry-level CNAs Non-responder study Methodology review by external psychometricians

7 Survey Instruments 1.NA survey Work environment 115 NA activity statements Last day of work Education and training Demographic Comments 2.NAE survey Work environment 115 NA activity statements Comments

8 Sample Selection Randomly selected 6,500 nursing directors from hospitals, nursing homes and long term care facilities Each director received three surveys to be distributed to one NAE and two entry-level CNAs Return rates: 485 facilities opted out of the study 21 return surveys due to bad addresses CNA adjusted return rate – 10.7% (n=1,016) NAE adjusted return rate – 11.1% (n=666)

9 Job Analysis Survey Results

10 NA Ethnicity and Gender Gender: 91.5% female; 8.5% male

11 NA Years of Experience

12 NAE Years of Experience Supervising NAs

13 Client Health Conditions

14 Client Age

15 Shift Worked

16 Most Performed Activities Activity 1 Year or less NA Activity # N % Not Perform Activity % Perform Activity 107 Ask for help when needed %100.00% 98 Respect client's need for privacy/confidentiality %99.80% 19 Follow Standard/Universal precautions (e.g., handwashing, personal protective equipment [PPE], isolation guidelines) %99.80% 56 Allow client to do things at his/her own pace %99.60% 93 Follow client's plan of care %99.50% Activity Nurse Aide Evaluator Activity # N % Not Perform Activity % Perform Activity 98 Respect client's need for privacy/confidentiality %100.00% 19 Follow Standard/Universal precautions (e.g., handwashing, personal protective equipment [PPE], isolation guidelines) %100.00% 102 Follow code of ethics for nurse aides %100.00% 107 Ask for help when needed %99.80% 29 Use proper body mechanics %99.80%

17 Least Performed Activities Activity 1 Year or less NA Activity # N % Not Perform Activity % Perform Activity 26 Perform cardiopulmonary resuscitation (CPR) %51.70% 7 Assist client to fill out meal menu %53.10% 23 Clear foreign-body airway obstruction (FBAO) %57.40% 39 Prepare client for diagnostic test, procedure, or surgery (e.g., NPO) %58.50% 46 Collect and label stool, urine or sputum specimens %62.70% Activity Nurse Aide Evaluator Activity # N % Not Perform Activity % Perform Activity 31Apply and monitor restraints %52.50% 7Assist client to fill out meal menu %59.40% 51Perform and record pulse oximetry %59.50% 26 Perform cardiopulmonary resuscitation (CPR) %65.90% 23Clear foreign-body airway obstruction (FBAO) %69.90%

18 Performance Ratings

19 Most Important Activities Activity 1 Year or less NA Activity # N Avg. Import Std. err. 19Follow Standard/Universal precautions (e.g., handwashing, personal protective equipment [PPE], isolation guidelines) Apply and respond to client safety alarms Report any suspected neglect, mistreatment or abuse Report and record unusual incidents (e.g., errors, injuries, falls) Follow Health Insurance Portability and Accountability Act (HIPAA) Activity Nurse Aide Evaluator Activity # NAvg. Import Std. err. 19Follow Standard/Universal precautions (e.g., handwashing, personal protective equipment [PPE], isolation guidelines) Report any suspected neglect, mistreatment or abuse Report and record unusual incidents (e.g., errors, injuries, falls) Apply and respond to client safety alarms Follow Health Insurance Portability and Accountability Act (HIPAA)

20 Least Important Activities Activity 1 Year or less NA Activity # NAvg. Import Std. err. 5Provide nail care Provide foot care Assist client to fill out meal menu Assist or encourage family to help with client's care Provide physical comfort measures (e.g., back rubs) Activity Nurse Aide Evaluator Activity # N Avg. Import Std. err. 34Assist nurse with dressing change Assist client to fill out meal menu Assist or encourage family to help with client's care Provide nail care Assist client with recreational activities

21 Mean Importance Ratings

22 Conclusions and Next Steps Respondents found activities listed in the surveys to be representative of CNA work. Importance ratings given by CNAs and NAEs were similar. Results obtained from job analysis surveys were used to determine test plan and weighting of test plan areas.

23 2011 NNAAP Test Plan Specifications

24 Reports and Technical Briefs NNAAP 2009 Job Analysis Report (available on NCSBN website this summer) 2011 NNAAP Test Plan Report is available for download at https://www.ncsbn.org/1721.htm https://www.ncsbn.org/1721.htm

25 NNAAP Test Development Process 1.Job Analysis 2.Content Outline 3.Item Writing and Item Review 4.Subject Matter Expert (SME) Panel Review 5.Editorial Review 6.Building Test Forms 7.Setting the Passing Standard 8.Pretesting of Items 9.Administering Examinations

26 Standard Setting To determine a point on the ability continuum by which a candidate must exceed to be deemed competent Specific to the NNAAP examination, the goal of standard setting is to determine the level of nursing ability necessary for certified entry- level nurse aides to practice safely and effectively. Passing standard = passing score = cutscore

27 (cont) Standard Setting Where the results of the standard-setting process have highly significant consequences... those responsible for establishing the cut scores should be concerned that the process by which cut scores are determined be clearly documented and defensible. (AERA/APA/NCME, Standards for Educational and Psychological Testing, 1999, p. 54)

28 Assumptions for Standard Setting Certification and licensure is based on an assessment (usually an exam) that is content-valid, scalable and reliable. We can create a defensible process that can quantify "how much" knowledge or skill a person must have to be considered minimally competent.

29 Scores on NNAAP Exam Type of score is very important concept Candidates either "pass" or "fail their exams. The NNAAP uses a criterion-referenced standard setting process through the definition of minimally competent candidate. We are not asking which candidates were in the top XX% on the exam. We are only concerned with the pass or fail decision.

30 Certification and licensure examinations are designed to: Protect the public from unsafe practitioners Ensure "best practices" of the profession Require entry-level professionals to achieve a minimal level of knowledge or skill in their field to perform their job safely and effectively. Importance of Standard Setting

31 (cont) Importance of Standard Setting If standard is set too low, we will certify some candidates who are unqualified. If standard is set too high, we will deny a certification to some candidates who are qualified or competent. Set appropriate standard while referencing the criterion.

32 Important Caveats No true value exists Policy decision, related to mission of organization (e.g., public protection) Standards should be revisited when test specifications, scope of practice/range of authorized duties, education programs, and/or other factors change

33 NNAAP Standard Setting Process 1.Overview of standard setting process 2.SMEs discussed qualifications for entry-level NAs 3.SMEs reviewed NNAAP content outline 4.Training on standard setting methodology 5.SMEs rated practice items 6.SMEs provided round 1 ratings of actual items 7.SMEs discussed round 1 ratings 8.SMEs provided round 2 ratings 9.Gather validity evidence 10.Determine cutscore

34 Subject Matter Expert (SME) Panel Representative of practice settings and specialties, regions Knowledgeable regarding practice analysis, test specifications All panelists are RNs with minimum of two years of nursing experience All panelists work with CNAs Ten SMEs served on the panel of judges

35 SME Panel Characteristics Characteristics #% NCSBN Geographic Area I330% II220% III330% IV220% Year of Post Licensure Experience 1 to 15 years220% 16 to 30 years770% 31 to 45 years110% Work Setting Nursing home770% Hospital220% Other long term care110% Certifications and Licenses Held (other than RN)* C NA880% LPN/VN440% * Several panelists hold multiple licenses and certifications.

36 The Minimally Competent Candidate To establish a passing standard, we focus on the examinees that possess just enough knowledge, skills and ability to practice entry-level nursing safely and effectively We don't focus on high or low ability examinees We focus on those who are "on the fence"

37 The Minimally Competent Candidate What distinguishes candidates with "just enough" knowledge, skills and ability from the other two groups? Knowledge/skill of the fundamentals Little advanced knowledge Have learned enough to move on (no remedial learning required) Should vs. would

38 Modified-Angoff Method Rate how minimally competent entry-level CNAs would perform on each NNAAP item. Criterion-referenced Common in medical and health-related credentialing Vast research base, defensible Used in NCLEX-RN, NCLEX-PN, MACE and English proficiency standard setting workshops

39 Minimal Requirements for Entering the NA Profession Training program is accepted by state boards of nursing and departments of health services Nurse aide has minimum 75 hours of class room training Nurse aide has minimum 16 hours of clinical training Nurse aide is at least 16 years old and in good mental health Nurse aide works in the following settings: long term care, acute care, assisted living or community health centers

40 Results from Standard Setting Workshop Form and Round % Cut ScoreRaw Cut Score (60 item test) Standard Deviation Rating Reliability Form A Round %48.20 (49) Form B Round %48.80 (49) Form A Round %48.67 (49) Form B Round %49.12 (50) Note: Ratings from outlier were removed from the above results.

41 Panel Recommendations SMEs reviewed results of standard setting workshop and their likely impact on NNAAP pass rate. Upon reviewing the information including SMEs own knowledge about the industry, all 10 SMEs agreed to a cut score of 47 out of 60 items. This new cut score will be implemented with the launch of 2011 NNAAP test forms.

42 Post-workshop Survey QuestionMean RatingStandard Deviation Question 1: I understood the major goals of the standard setting workshop Question 2: I feel the training was adequate Question 3: I feel that the discussion of the minimally competent nurse aide candidate was comprehensive Question 4: I understood the group consensus on a minimally competent nurse aide candidate Question 5: I understood my task throughout the standard setting process Question 6: I understood the Modified Angoff rating process Question 7: I understood the Beuk rating process. * Question 8: I had sufficient time to reflect on my first rating Question 9: I had sufficient time to reflect on my final rating Question 10: I feel the group discussions were productive Question 11: I feel my opinion was considered Question 12: I feel the passing standard recommended by the group was appropriate Rating Scale: 1=Strongly disagree, 2=Disagree, 3=Agree, 4=Strongly agree

43 SME Feedback I enjoyed the opportunity to meet other NA Educators from different states and be able to understand the variety of challenges each of us face. I feel honored to be a part of this process. Supportive, well informed group leaders, appreciative of our input, made the process understandable. I would gladly come back anytime. I learned a great deal about the process. I was very impressed with the professionalism and knowledge of the presenters. This is a very comprehensive process and I am honored to be a part of it.

44 Next Steps 2011 NNAAP forms will be launched in January 1, These test forms were constructed according to test specifications generated from the 2009 job analysis of nurse aides. All test forms were equated to be comparable in difficulty. Passing score for all 2011 test forms is 47 out of 60. A larger number of items will be pretested in 2011 to build NNAAP item pool. Next NNAAP item writing/review workshop will be hosted in March 2011

45 Reports and Technical Briefs Test Plan Report – https://www.ncsbn.org/2011_NNAAP_Te st_Plan- Test_Specifications_Report_links.pdf https://www.ncsbn.org/2011_NNAAP_Te st_Plan- Test_Specifications_Report_links.pdf Standard Setting Report – complete report will be mailed to clients; proprietary information.

46 Questions?


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