Quantitative research methods and applications

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Project Title: Do case studies in nursing school curricula result in a higher proportion of passing grades on the HESI exit exam?

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Abstract

The HESI exit examination is a standardized test used to evaluate the skills and knowledge developed by students in nursing school. Achievement on the HESI exam is considered to be indicative of how effective these students will be as professional nurses. It is important to develop ways to improve the knowledge and skills developed by nursing students. This study aims to investigate the impact that curricula involving case studies has on the pass rate of the HESI exit examination. Schools that use instruction involving case studies will be compared to schools that do not use such instruction in regards to the proportion of students that pass the HESI examination. A non-experimental design will be utilized, conducted as an observational correlation study. The hypothesis is that there will be a positive correlation between case studies and higher pass rates on the HESI exam.

Conceptualization of the Problem

RN program nursing schools strive to provide students with the highest quality of education possible. Curricula are designed to provide students with the knowledge and skills that will prepare them for success in the field of nursing. The most effective way to measure the acquisition of this crucial knowledge and skill is the HESI exit examination. This is a standardized test that determines whether students can demonstrate that they have acquired a sufficient base of knowledge to progress into employment in the field of nursing.

Different curricula may result in different overall results for students taking the HESI exit examination. It should be of the highest priority to university faculty that students are provided with instruction that most effectively prepares them for the challenge of the HESI exit examination. On method of instruction that may prove beneficial for students is the provision of case studies. Case studies function to better illustrate problems being discussed in the curriculum, and aid students in the development of greater comprehension of subject matter. Furthermore, case studies may allow students to develop a better sense of how theories translate into practice.

The purpose of this study is to examine the impact that case studies in nursing school curriculum has on HESI exit examination pass rates. In particular, the pass rates of RN program schools that use case studies will be compared to the pass rates of schools that do not utilize case studies. It is hypothesized that schools that use case studies will have significantly higher HESI exit exam pass rates than schools that do not use case studies.

Hypotheses

The hypothesis of the study is that students in BSN and ADN programs who use HESI (Health Education Systems, Inc.) standardized case studies will demonstrate a higher pass rate on the HESI exit examination in comparison to students in BSN and ADN programs that do not use HESI standardized case studies.

Research Design

Design

The non-experimental design that will be used to address this research question is an observational correlation study. It is expected that a significant, positive correlation will be observed between the presence of standardized case studies and the proportion of passing HESI exit examination scores. The aim of this study will be to observe the naturally occurring correlational relationship between student exposure to standardized case studies and resultant proportion of students who pass the HESI exit examination..

The independent or predictor variable in this study (the presence of standardized case studies) was not manipulated by the researcher because the observation of correlations between the exposure to case studies and the outcome examination scores that occur naturally necessitates minimal intrusion by the researcher. The researcher is not able to control the independent variable, and instead randomly samples programs that use HESI case studies and those that do not. The proportions of students that pass the HESI exit examination between programs that include case studies in their curriculum are compared to those that do not. The researcher in this situation is only an observer, investigating a natural occurrence that would take place whether or not the researcher was involved in any respect. The non-manipulation of the independent variable is inherent to the non-experimental design utilized in the study.

The hypothesis of the study is that among BSN and ADN programs that use HESI case studies, there will be a positive correlation between utilization of the case studies and the proportion of students that pass the HESI exit examination. Moreover, utilization of HESI standardized case studies in the curriculum of schools of nursing results in a greater proportion of students that pass the HESI exit examination in comparison to schools that do not use the case studies.

Methodology

Setting

The setting for this study is university campuses that have RN programs that are clients of HESI. Specifically, the nursing instruction involving case studies is delivered in classroom settings. The HESI exit examinations are administered in either classroom or examination hall settings.

Population, and sample

The population involved in this study is nursing students at schools with RN programs who were clients of HESI, Inc., 2005, which either are receiving instruction involving the utilization of standardized case studies, or are not receiving this type of instruction. The settings for the study are departments of nursing on University campuses who were clients of HESI, Inc. In 2005. The independent variable or predictor variable in the study is the presence or absence of standardized case studies in the curriculum. Since this study is non-experimental in nature and aims to assess the correlational relationship between the presence of case studies and resulting exam scores, this predictor variable will not be manipulated by the researcher. Instead, the researcher will observe the natural results that occur among students that receive standardized case studies in their curriculum in comparison to those that do not. The dependent or outcome variable in this study is the HESI exit examination scores.

Recruitment, Retention and Training

Recruitment techniques include incentives (monetary), personal contact through phone, email, or mail to potential participants, as well as advertisements in areas where the target population can be reached. The recruitment strategy that would be most effective for the sample of the present study is through contact to every school of nursing with RN programs that were clients of HESI, Inc. This contact could explain the importance of the research and explain the requirements involved for participation in the study.

A recruitment strategy that could be employed for this study is direct contact with schools of nursing that were HESI, Inc. clients in 2004. This contact could include an explanation of the importance of the research and the requirements for participation. This technique for recruitment is optimal due to the specificity of the target population under study.

Retention could be enhanced through the use of incentives for schools that participate in the study.

A retention strategy that could be used for the sample in the present study is to require that participating schools sign a written consent/commitment form that outlines what is expected for all programs participating in the study. Also, an incentive of some sort could be offered to participating programs upon completion of the study in order to retain the sample.

Sample size and method of determination

Sampling Method

The sampling technique that could be used for this study is simple random sampling. The sample would be randomly selected from the target population of nursing schools that were clients of HESI, Inc. This technique would be used because it would create a representative sample, and would furthermore ensure generalizability of the results. In order to obtain a random sample, all HESI schools could be entered into a computer program that would randomly generate a selection of schools that could be contacted for recruitment for the study.

An estimated effect size of -0.57 was calculated. Data from the study by Habib et al. (1999) was used to calculate an estimated effect size. This estimated effect size was calculated by subtracting the mean knowledge acquisition score of students in a case-study-based class (COPBL class) from the mean knowledge acquisition score of students in the traditional curriculum class. The resultant value was than divided by the pooled standard deviation of the population, which is an average of the standard deviations of the two study groups. The result of this equation gave an estimated effect size of -0.57.

Based on this estimated effects size, it was estimated that the sample size needed for this experiment is 126 nursing schools. In order to increase effect size, dosing techniques could be employed. Strategies that might be employed to increase the "dose" of the proposed intervention would be to increase the number of case studies used in the curriculum for the intervention group, or to increase the frequency with which the case studies are administered in lessons for the nursing students. For example, if one case study is presented per week in the curriculum, this could be "dosed up" by presenting two or three case studies per week to the classes in the intervention group. This could have the desired effect of increasing the expected effect size.

Attrition rates must be accounted for when determining sample size. If there was a 30% attrition rate, the determined sample size would remain realistic, since 88 nursing schools is still a considerable number of schools to work with as long as the numbers of schools that do and do not use case studies in the study are relatively equal.

Collecting a sample of this size would not take a large amount of time. The recruitment process would involve identifying BSN and ADN programs who are HESI clients and either do or do not use standardized case studies. Enough programs would have to be identified that fall into each group for the study. No agencies would be required for the collection of this sample. The information and means necessary for recruitment for this study are available directly to the researcher through various accessible resources, and the researcher is able to self-sufficiently recruit for the study through personalized direct contact with nursing schools.

The timeframe required for this study would be the duration of the nursing curriculum, which is 5 semesters or 20 months. A sample inclusion criterion would be schools of nursing that were clients of HESI, inc. A sample exclusion criterion would be schools that were not clients of HESI, inc. These criteria would be used to ensure that the intervention under investigation (the use of HESI standardized case studies) is the treatment being measured.

Instrumentation

1). Demographic data

Demographic data will be collected on all schools involved in the study. This data will include details such as the breakdown of students according to age, sex, educational background, etc.

2) HESI exam

The measurement tool that will be used to measure the proportion of passing grades within schools that do or do not use case studies as part of their curricula is the HESI exit exam. This instrument will be chosen because it is a widely used, standardized test that all nursing students at schools that are HESI clients must complete in order to pursue careers within the field of nursing. Also, the presence of case studies in the curricula may affect the scores on the HESI exam, influencing the proportion of passing and failing grades within each school.

It is hypothesized that the presence of case studies within the curricula will result in schools adhering to this type of curricula exhibiting a larger proportion of passing grades in comparison to schools that do not utilize case studies in their curricula. The HESI exit exam comprehensively assesses the knowledge attained by students in these nursing schools, and it is therefore an appropriate measure of the dependent variable and will be useful for the study.

The operational definition of the HESI exit exam is compatible with the conceptual definition of the variable. The dependent variable (proportion of passing grades) may be conceptually defined as an indication of how effective the presence of case studies in the nursing school curricula is at improving nursing students' comprehension and retaining of knowledge acquired from curricula. The HESI exam is compatible with this conceptual definition because it is designed to assess the particular knowledge that nursing students are exposed to and expected to retain from instruction and curricula.