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Chapter 15Social, Ethical, andLegal IssuesOermann & GabersonEvaluation and Testing in Nursing Education4th edition


Social, Ethical, and Legal Issues

♦ Nursing education programs under increasing pressure for public accountability – Quality of programs – Competency of graduates

♦ Testing and assessment often used to provide evidence of quality and competence

♦ Increasing use of assessment and testing → interest in and concern about fairness, appropriateness, and impact

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Social Issues

♦ Test scores can have positive and negative consequences for individuals– Provide information used in making decisions that

are important to society and to individuals♦ Tests used to help select individuals for

occupational roles – Schools affect possible career path of individuals

by controlling admission to educational programs

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Social Issues: Admission Decisions

♦ Select candidates who are likely to practice nursing competently and safely– Tests often used in admission process

♦ Poor admission decisions result from improper use of testing or misinterpreting test scores– False positive: Student admitted but later found to be

incompetent to practice nursing safely → public harm– False negative: Deny admission to individual who would be

competent to practice nursing → person is denied access to the profession

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Social Issues: Occupational Uses of Testing♦ Tests used for: – Initial decision to employ – Ensuring competence at end of orientation– Certifying continuing knowledge and skill

♦ Decisions important to employee, employer, and society– Employer certifies that the individual is competent

for the role

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Social Issues: Assessment Bias

♦ Concern that tests are biased or unfair to certain groups of test-takers

♦ Major purpose of testing is to identify important differences among people with regard to knowledge, skills, or attitudes– Discrimination is not unfair when differences in scores

represent real differences in those domains– Assessment bias can occur by misinterpreting scores or

drawing conclusions that go beyond the assessment

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♦ Differential validity of an assessment result for a group of people being assessed– Score does not have the same meaning for all those

who were assessed• Interpretation may be inaccurate for relevant subgroup

– Example• Low test score interpreted to mean inadequate

knowledge of the content• May be inaccurate for students with learning disabilities

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♦ Differential item functioning (DIF)– Individual test items discriminate against subgroups of

test-takers– Subgroups with equal ability (equal total test scores)

perform differently on the item• Does not necessarily confirm item bias• Could be construed as content and experience differential

– Two forms• Cultural bias• Linguistic or structural bias

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Cultural Bias

♦ Item contains irrelevant references to a particular culture – Content related to cultural differences essential to safe

nursing practice is appropriate

♦ More likely to be answered incorrectly by students from a minority group

♦ Jokes, puns, other forms of humor also may contribute to cultural bias

♦ Prevent by careful peer review for discernible bias

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Linguistic or Structural Bias

♦ Poorly written test item – Lengthy, unclear, awkwardly worded– Interferes with student’s understanding of the teacher’s

intent

♦ Problem for all students, but more likely to discriminate against certain subgroups– English language learners – Those with learning disabilities – Cultural minorities—less likely to ask for clarification

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Social Issues: Test Bias

♦ Prevent bias by anonymous test scoring and grading– Use throughout a course– Each student has a grading-system number to use

on every assessment– Scores recorded by these code numbers – Teacher unaware of student identity until

grades have been assigned

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Social Issues: Grade and Score Inflation♦ Trend toward inflation of test scores and

grades at all educational levels ♦ Distorts the meaning of test scores and ↓

validity of decisions made with them ♦ All scores and grades compressed near top of

distribution– Difficult to discriminate among students– Decreases value of testing

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Grade Inflation: Common Issues♦ Student expectations—consumer rights♦ Institutional policies

– Late course withdrawal dates– Mandatory student evaluation of teaching

♦ ↑ number of older students—greater focus on achievement

♦ Faculty beliefs – Effect of grading on student self-esteem– What constitutes satisfactory performance– Subjective nature of grading

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Grade Inflation: Common Issues

♦ Clinical grading issues♦ Increasing use of part-time faculty members♦ These two issues related– Most part-time faculty members teach in clinical area– Full-time faculty members reluctant to assign failing grades

in clinical courses, especially in beginning courses – Belief communicated to part-time faculty members

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♦ Frequent grading discrepancies between theory and related clinical courses– Especially where clinical practice is assigned a

letter grade – Higher clinical grades tend to inflate the overall

grade point average– May result in marginal students completing the

course or program but failing NCLEX®

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♦ “Rule of C” for clinical grading – D grade virtually eliminated as a grading option– May be related to program policies that require minimum

grade of C to pass a clinical course– Faculty members reluctant to assign failing grades may

award C grades to students with marginal performance– B grade becomes symbol for average or acceptable

performance– Grade compression (three grade levels instead of five)

contributes to grade inflation

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♦ Increasing pressure of accountability for educational outcomes– Effectiveness of instruction judged on basis of

students’ test performance– Teacher may “teach to the test” • Distorts the curriculum

– Distinction between teaching to the test and teaching content to be sampled by the test and relevant test-taking skills

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Social Issues: Effects of Testing on Self-Esteem♦ Concern that tests make students anxious, fearful,

and discouraged → harm to self-esteem♦ No empirical support for this concern– High self-esteem not essential to perform well– Anxiety about an upcoming test is normal and helpful

• Motivates students to prepare thoroughly to demonstrate best performance

• Testing is a common life event; need to learn effective coping methods

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Test Anxiety

♦ Types of test-anxious students– Poor study skills and do not understand the content – Good study skills and understand the content

but fear they will do poorly no matter how much they prepare

– Believe that they have good study skills but do not

(Nitko & Brookhart, 2011)

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Test Anxiety: Helping Students

♦ Identify reason for test anxiety– Distinguish from learning disability or depression

♦ Refer to specific resources– Study skills– Test-taking strategies• Most students can benefit

– Stress-reduction techniques

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Social Issues: Testing as Social Control♦ Using threat of tests and implied threat of low

test grades to control student behavior– Unannounced tests to motivate students to

prepare for and attend class• Unfair testing practice• Students need sufficient time to prepare for a test to

demonstrate their maximum performance

– Using tests in punitive, threatening, or vindictive ways is unethical

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Ethical Issues

♦ Ownership and security of tests and test results – Relates to bioethical standards of privacy,

autonomy, veracity– Examples• Truth-in-testing practices• Protecting the privacy of assessment results• Access to student records containing assessment

results

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Ethical Issues

♦ Violations of professional boundaries– Relates to bioethical standard of fidelity• Faithfulness in relationships and matters of trust• Requires teachers to act in the best interest of students

– Examples• Faculty misuse of unequal power to affect student’s

academic progress or ability to gain employment • Teachers who have personal relationships with students

may be accused of grading based on favoritism or retaliation

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Ethical Issues

♦ Standards for Ethical Testing Practices– Code of Fair Testing Practices in Education

(Joint Committee on Testing Practices, 2004)– Code of Professional Responsibilities in Educational

Measurement (NCME, 1995) – Standards for Educational and Psychological Testing

(AERA, APA, & NCME, 1999) • Standards for test construction, administration, scoring, and reporting• Fairness in testing• Testing individuals with disabilities and different linguistic

backgrounds

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Common Elements of Fair Testing Standards♦ Teachers responsible for the quality of the tests they

develop and select ♦ Test administration procedures must be fair to all students ♦ Teachers responsible for accurate scoring of tests ♦ Students should receive prompt, meaningful feedback♦ Test results should be interpreted and used in valid ways♦ Teachers must communicate test results accurately♦ Teachers must anticipate consequences of using test results

and minimize negative impact on students

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High-Stakes Assessments

♦ Used for decision making that results in serious consequences for test-takers, teachers, and administrators of educational programs

♦ Example– use of standardized end-of-program tests to identify

students at risk of NCLEX failure and to deny program progression or graduation to students who are predicted to fail the licensure examination

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♦ Use of a single standardized test as a basis for progression and graduation decisions raises concerns about – whether any such test reliably predicts success among

various subgroups of an increasingly diverse group of learners

– the need for multiple approaches to assessment of knowledge and skill when high-stakes decisions are based on the assessment

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♦ Most standardized tests used as exit exams are intended to predict whether an individual student is likely to pass the NCLEX– Much less accurate in predicting the likelihood of failure

♦ Progression or graduation policies requiring high-stakes testing can distort the intended purpose of NCLEX pass-rate requirements as a measure of program quality

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♦ National League for Nursing’s Fair testing guidelines for nursing education (2012) emphasize obligation of faculty members and administrators to– use multiple assessment approaches when making high-

stakes decisions.– undertake comprehensive review of factors involved in

developing and implementing high-stakes testing.– review other factors that affect NCLEX pass rates and other

measures of program quality.

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Legal Issues

♦ Evaluation of students with disabilities– Americans with Disabilities Act (ADA) of 1990 prohibits

discrimination against qualified individuals with disabilities• Defined as persons with physical or mental impairment that

substantially limits major life activities

– Nursing education programs obligated to accept and educate qualified individuals with disabilities• Program must provide reasonable accommodations• Does not require lower standards

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Legal Issues

♦ ADA requirements for assessment– Must make reasonable accommodations for students with

disabilities – Examples of accommodations

• Oral testing• Computer testing• Modified answer format• Extended testing time • Test readers or sign language interpreters• Private testing area• Large type for printed tests

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Legal Issues

♦ NCLEX® policies regarding accommodations for learning disabilities– Candidates permitted reasonable accommodations (e.g.,

extended testing time) if approved by boards of nursing in states where they applied for initial licensure

– Educational institutions must verify documentation of disabilities and students’ use of accommodations

– Speaking English as a second language is not considered a disability• Necessary for competent nursing practice in USA

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Legal Issues

♦ Concerns about providing reasonable testing accommodations for students with disabilities – Validity of the test result interpretations if the test was

administered under accommodated conditions for some students

– Privacy rights of students with disabilities if use of accommodations is noted along with test scores

– Faculty members should be guided by accommodation policies developed by their institution

– New assessment policies should be reviewed by legal counsel to ensure ADA compliance

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