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The effect of a self-instructional module on the level of questions posed by nursing instructors during… Craig, Jennifer 1979

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THE EFFECT OF A SELF-INSTRUCTIONAL MODULE ON THE LEVEL OF QUESTIONS POSED BY NURSING INSTRUCTORS DURING POST-CLINICAL CONFERENCES by JENNIFER CRAIG B.Sc.N. U n i v e r s i t y o f B r i t i s h Columbia, 1976 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE: FACULTY' OF.GRADUATE STUDIES • »•-••> -s v.-*..- .„ ; ,, i n the Department, of Education We a c c e p t t h i s t h e s i s as conforming to the r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA May, 1979 (c) J e n n i f e r Lynn C r a i g , 1979 I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r a n a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d s t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e Head o f my D e p a r t m e n t o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . D e p a r t m e n t o f S l ^ - n ^ £ o u ^ o i s > > - i . The U n i v e r s i t y o f B r i t i s h C o l u m b i a 2075 W e s b r o o k P l a c e V a n c o u v e r , C a n a d a V6T 1W5 D a t e feWu*^ f<|' , i<|7cj i i ABSTRACT The effect of a s e l f - i n s t r u c t i o n a l module on the l e v e l of questions posed by nursing instructors during p o s t - c l i n i c a l conferences. The education of many c l i n i c a l nursing instructors prepared them to nurse, not to teach. When conducting p o s t - c l i n i c a l conferences, the nursing instructor i s expected to help students integrate t h e i r exper-iences and relate them to classroom teaching and nursing theory. One of the many s k i l l s required to do t h i s , i s the posing of thought-provoking questions. The purpose of this study was to prepare, and evaluate the effectiveness of, educational materials for c l i n i c a l nursing instructors i n order that they may improve thei r questioning s k i l l s during post-c l i n i c a l conferences. A s e l f - i n s t r u c t i o n a l learning module was designed to teach nursing instructors how to ask questions directed toward the higher levels of cognitive processes. A question c l a s s i f i c a t i o n scheme based on Bloom's Taxonomy was developed. Learning a c t i v i t i e s included reading, i d e n t i f i c a -tion of questions, generation of questions, and analysis of questions asked during a recording of one of the learner's p o s t - c l i n i c a l conferences. The question addressed i n the experimental phase of t h i s study was, "Can the l e v e l of questions asked by nursing instructors during post-i i i c l i n i c a l conferences be raised by the study of a specific self-instructional module?" The design of the study was a pretest - posttest control group design. The subjects were fourteen nursing instructors representing four faculties of nursing. Six instructors formed the experimental group and eight, the control group. The independent variable was the self-instructional module. The dependent variable was the percentage of high level questions asked by nursing instructors. High level questions were considered to be those that addressed the application level, or above, of Bloom's Taxonomy. Data were obtained on half-hour audiotapes of post-clinical conferences. A l l questions asked by both instructors and students were transcribed into written form and coded according to the classification scheme developed for this study. When the gain scores of the experimental group were compared with those of the control group, a significant difference was found. It was concluded that the self-instructional module had been effective in raising the level of questions asked. A second hypothesis to test the relation between the level of questions asked by instructors and the level of questions asked by their students, was abandoned due to an insufficient number of student questions. i v TABLE OF CONTENTS CHAPTER Page I. I n t r o d u c t i o n 1 1.1 Statement o f the Problem 1 1.2 Background o f the Problem 2 1.3 J u s t i f i c a t i o n f o r the Study 7 1.4 D e f i n i t i o n o f Terms 10 I I . Review o f S e l e c t e d R e l a t e d L i t e r a t u r e 12 2.1 C l i n i c a l C o n f e r e n c e s 12 2.2 C l a s s i f i c a t i o n o f Q u e s t i o n s 15 2.3 Q u e s t i o n i n g B e h a v i o r o f Teachers 18 2.4 E f f e c t o f Q u e s t i o n i n g on Student B e h a v i o r . . 21 2.5 I n s t r u c t i o n i n Q u e s t i o n i n g 27 Summary 29 I I I . Development o f the Module 30 3.1 Preview 30 3.2 D e f i n i t i o n o f O b j e c t i v e s 32 3.3 I n s t r u c t i o n a l Sequence 34 3.4 Content V a l i d i t y 36 3.5 F i e l d T e s t 39 Summary 39 IV. F i e l d T e s t 41 4.1 S u b j e c t s 41 4.2 De s i g n o f the Study 43 4. 3 Pro c e d u r e 45 4.4 Data C o l l e c t i o n 46 Summary 49 V CHAPTER Page V. Results 50 5.1 Data 50 5.2 Analysis 51 5.3 Discussion of Findings 53 Summary 57 VI. Summary, Conclusions and Recommendations 58 6.1 Summary 58 6.2 Conclusions 60 6.3 Recommendations 62 BIBLIOGRAPHY 64 APPENDICES Appendix A: Explanatory Letter to Prospective Volunteers 68 Appendix B: Transcribed Questions Sheets 74 Appendix C: The S e l f - I n s t r u c t i o n a l Module 81 v i LIST OF TABLES TABLE Page I. I n t e r r a t e r R e l i a b i l i t y 48 I I . T o t a l number o f q u e s t i o n s and p e r c e n t o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s and t h e i r s t u d e n t s 52 I I I . P r e t e s t and p o s t t e s t s c o r e s o f the e x p e r i m e n t a l and the c o n t r o l group 54 IV. Formulae used t o c a l c u l a t e the v a r i a n c e and t h e t t e s t 55 vii LIST OF FIGURES AND ILLUSTRATIONS FIGURE Page 1. L e t t e r t o c o n t e n t v a l i d a t o r s 38 2. D i r e c t i o n s to r a t e r s 47 v i i i ACKNOWLEDGEMENT I wish to ex p r e s s my s i n c e r e thanks to Dr. Gordon Page f o r h i s i n v a l u a b l e guidance and p a t i e n c e i n t h i s , and o t h e r , endeavors. Thanks a r e a l s o due to Dr. W a l t e r B o l d t and Dr. M a r i l y n Willman f o r t h e i r s u p port and encouragement. I a l s o extend my a p p r e c i a t i o n to the F a c u l t i e s o f N u r s i n g i n the c o l l e g e s I approached f o r t h e i r i n t e r e s t and h e l p . Research r e q u i r e s a s s i s t a n c e from a v a r i e t y o f s o u r c e s o u t s i d e the scope o f the u n i v e r s i t y . I am i n d e b t e d to my n u r s i n g f r i e n d s , E l i z a b e t h Bregg, Norma F o s t e r , B a r b a r a B r a d l e y , V a l e r i e S p r o u l e and Deborah T a y l o r f o r t h e i r f r a n k a p p r a i s a l s ; t o Margaret McLeod f o r h e r hours o f t y p i n g ; and to my f a m i l y f o r t h e i r endurance. -1-CHAPTER I  I n t r o d u c t i o n C hapter I i n t r o d u c e s the r e a d e r to the purpose o f the s t u d y and the e x p e r i m e n t a l h y p o t h e s e s . The statement of the problem i s f o l l o w e d by a d i s c u s s i o n of e f f e c t i v e c l i n i c a l t e a c h i n g , r e s e a r c h undertaken i n t h i s a r e a , and the d e l i n e a t i o n o f one p a r t i c u l a r s k i l l , q u e s t i o n i n g , on which the s t u d y f o c u s e s . The importance o f t h i s s k i l l i n a t e a c h e r , and the proven l a c k of i t , a r e d i s c u s s e d , and f i n a l l y p e r t i n e n t terms a r e d e f i n e d . 1.1 Statement of the Problem The purpose o f t h i s study was to develop and e v a l u a t e a s e l f -i n s t r u c t i o n a l module f o r c l i n i c a l n u r s i n g i n s t r u c t o r s i n o r d e r t h a t they may improve t h e i r q u e s t i o n i n g s k i l l s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s . R e l a t i v e to t h i s purpose, the e x p e r i m e n t a l hypotheses were t h a t : 1. There w i l l be a s i g n i f i c a n t i n c r e a s e i n the p e r c e n t a g e of h i g h l e v e l q u e s t i o n s asked d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s by i n s t r u c t o r s who have used a s e l f -i n s t r u c t i o n a l module r e l a t i v e to i n s t r u c t o r s who have n o t . 2. There w i l l be a s i g n i f i c a n t c o r r e l a t i o n between the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s -2-d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s and the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by t h e i r s t u d e n t s d u r i n g t hese c o n f e r e n c e s . I n h e r e n t i n the second h y p o t h e s i s i s a p r e d i c t e d secondary e f f e c t o f the module, which i s t h a t i f i n s t r u c t o r s r a i s e the l e v e l o f t h e i r q u e s t i o n s as a r e s u l t o f the module, t h e i r s t u d e n t s w i l l a l s o r a i s e the l e v e l o f t h e i r q u e s t i o n s . S i n c e the g e n e r a l o b j e c t i v e s o f p o s t - c l i n i c a l c o n f e r e n c e s a r e to a s s i s t s t u d e n t s i n a n a l y z i n g , s y n t h e -s i z i n g and e v a l u a t i n g , t h i s secondary e f f e c t i s e x t r e m e l y p e r t i n e n t to the assessment o f the e f f e c t i v e n e s s o f the module. 1.2 Background o f the Problem A c o n t i n u a l problem f a c e d by many n u r s i n g i n s t r u c t o r s who t e a c h i n two-year c o l l e g e programs i s t h a t t h e i r e d u c a t i o n p r e p a r e d them to n u r s e , n o t to t e a c h . The m a j o r i t y o f these i n s t r u c t o r s w i t h i n B r i t i s h Columbia a r e p r e p a r e d to the b a c c a l a u r e a t e l e v e l and t h e i r e d u c a t i o n a l program d i d not always i n c l u d e c o u r s e s i n e i t h e r c l a s s r o o m t e a c h i n g o r , and more s i g n i f i c a n t l y , i n c l i n i c a l t e a c h i n g . Some i n s t r u c t o r s may have taken e l e c t i v e s from a F a c u l t y o f E d u c a t i o n . Undergraduate c o u r s e s from t h i s f a c u l t y , however, are d e s i g n e d to p r e p a r e t e a c h e r s who work w i t h c h i l d r e n i n a c l a s s r o o m s e t t i n g . W hile many e d u c a t i o n a l p r i n c i p l e s and t e a c h i n g s t r a t e g i e s may be t r a n s f e r r e d t o the c l i n i c a l s e t t i n g , the n u r s i n g i n s t r u c t o r i s f a c e d w i t h o b s t a c l e s t h a t do not a r i s e i n a s c h o o l - 3 -c l a s s r o o m . The c l a s s r o o m i s a f a m i l i a r domain to the t e a c h e r who n o r m a l l y works t h e r e every day. U n p r e d i c t a b l e c r i s e s a r e r a r e and the l e a r n i n g " t o o l s " a r e s t a t i c and p r e a r r a n g e d . The n u r s i n g i n s t r u c t o r , on the o t h e r hand, i s a " g u e s t " w i t h i n the c l i n i c a l s e t t i n g which i s a n o t o r i o u s l y u n p r e d i c t a b l e and changing environment. P a t i e n t s become, i n a sense, l e a r n i n g " t o o l s " which may be unknown to the i n s t r u c t o r b e f o r e they a r e a s s i g n e d to s t u d e n t s . P a t i e n t s a r e not s t a t i c o b j e c t s and may n o t be used as p i e c e s o f i n a n i m a t e equipment; t h e i r "use" i s a heavy r e s p o n s i b i l i t y f o r the i n s t r u c t o r . The t e a c h e r i n the c o n t r o l l e d environment o f the c l a s s r o o m i s a b l e to s u p e r v i s e s t u d e n t s a t work most o f the time. C l i n i c a l n u r s i n g i n s t r u c t o r s , however, a r e not a b l e to p r o v i d e t h i s c o n s t a n t s u p e r v i s i o n . A f t e r g i v i n g d i r e c t i o n s to the s t u d e n t s , the c l i n i c a l i n s t r u c t o r i s engaged i n s u p e r v i s i n g s t u d e n t s i n d i f f e r e n t a r e a s , w i t h d i f f e r e n t p a t i e n t s and where each s t u d e n t i s c o n c e i v a b l y p e r f o r m i n g a d i f f e r e n t t a s k . D u r i n g the p o s t - c l i n i c a l c o n f e r e n c e , the n u r s i n g i n s t r u c t o r i s e x p e c t e d to h e l p the s t u d e n t s i n t e g r a t e t h e i r e x p e r i e n c e s and i n c i d e n t s and r e l a t e them to c l a s s r o o m t e a c h i n g and n u r s i n g t h e o r y . Faced w i t h these c h a l l e n g e s , the n u r s i n g i n s t r u c t o r may w e l l ask, "What are the c h a r a c t e r i s t i c s o f an e f f e c t i v e c l i n i c a l t e a c h e r , and how can I a c q u i r e them?" Research on t e a c h e r e f f e c t i v e n e s s i n the f i e l d o f e d u c a t i o n numbers more than 10,000 p u b l i s h e d s t u d i e s . F o l l o w i n g a r e v i e w of t h i s r e s e a r c h , Dunkin and B i d d l e (1974) c o n c l u d e d t h a t "those who a r e s e e k i n g - 4 -s i m p l e answers to the problem o f t e a c h e r e f f e c t i v e n e s s a r e o n l y s l i g h t l y b e t t e r o f f today than they were twenty y e a r s ago" (p.16). McDonald (1972), i n s t r e s s i n g the need to de v e l o p a taxonomy o f t e a c h e r b e h a v i o r s , was even more p e s s i m i s t i c i n h i s b e l i e f t h a t "the s t a t e o f the a r t o f measuring t e a c h i n g b e h a v i o r can o n l y be d e s c r i b e d as d i s m a l " (p.58). T u r n i n g to e d u c a t i o n i n the h e a l t h s c i e n c e s , Walker (1971), Mayberry (1973), Evans and M a s s l e r (1976) and Myers (1977) conducted s t u d i e s to determine e f f e c t i v e c l i n i c a l t e a c h i n g b e h a v i o r s i n d e n t i s t r y . These i n v e s t i g a t o r s i d e n t i f i e d t e a c h e r b e h a v i o r s t h a t s t u d e n t s c o n s i d e r e d to be e f f e c t i v e i n the c l i n i c a l a r e a . The c h a r a c t e r i s t i c s o f e f f e c t i v e c l i n i c a l t e a c h e r s as determined by these s t u d i e s a r e d e s c r i b e d i n vague, e q u i v o c a l terms; f o r example, "Able t o communicate h i s knowledge o f d e n t i s t r y , " (Mayberry, 1973) and "Communicates c l e a r l y , " (Myers, 1977). The s p e c i f i c b e h a v i o r s t h a t c o n s t i t u t e these c h a r a c t e r i s t i c s and how they may be a c q u i r e d , were u n f o r t u n a t e l y not i d e n t i f i e d . N u r s i n g has been concerned w i t h e s t a b l i s h i n g c r i t e r i a f o r e f f e c t i v e t e a c h e r s f o r many y e a r s . McCann (1959), Barham (1965) and Jacobson (1966) a l l used the c r i t i c a l i n c i d e n t t e c h n i q u e t o i d e n t i f y and d i s t i n g u i s h between e f f e c t i v e and i n e f f e c t i v e t e a c h e r b e h a v i o r s . A number o f e v a l u a t i o n s t u d i e s have y i e l d e d l i s t s o f d e s i r a b l e be-h a v i o r s . B u t l e r and G e i t g e y (1970), Lowery, Keane and Hyman (1976), Armington, R e i n i k k a and C r e i g h t o n (1972), K i k e r (1973) and Dixon and Koerner (1976) asked f a c u l t y and/or s t u d e n t s to r a t e n u r s i n g i n s t r u c t o r s , and, u s i n g v a r i o u s methods, produced l i s t s o f b e h a v i o r s on which i n s t r u c --5-t o r s c o u l d be e v a l u a t e d . None o f t h e s e s t u d i e s have c o n c e n t r a t e d on c l i n i c a l t e a c h i n g as s e p a r a t e from c l a s s r o o m t e a c h i n g . The n u r s i n g i n s t r u c t o r who a s k s , "What a r e the c h a r a c t e r i s t i c s of an e f f e c t i v e c l i n i c a l t e a c h e r and how may I a c q u i r e them?" may be p r o v i d e d w i t h l e n g t h y l i s t s of b e h a v i o r s deemed d e s i r a b l e by n u r s i n g s t u d e n t s and f a c u l t y from the above s t u d i e s . Should she d e s i r e to " p r e s e n t h e r s u b j e c t i n an i n t e r e s t i n g f a s h i o n , " o r "convey e x c i t e m e n t and e n t h u s i a s m , " she would f i n d no recommendations i n the s t u d i e s on how to a c h i e v e these ends. In examining these l i s t s o f b e h a v i o r s , one a s k s , " I s t h e r e a common element; a b e h a v i o r t h a t has been i d e n t i f i e d i n a l l the s t u d i e s ? " " I s t h e r e a common b e h a v i o r t h a t may be improved upon w i t h o u t r e q u i r i n g the n u r s i n g i n s t r u c t o r t o undergo a major p e r s o n a l i t y change?" The f o l l o w i n g b e h a v i o r s have been s e l e c t e d from the above s t u d i e s i n n u r s i n g as b e i n g s i m i l a r . 1. "The e f f e c t i v e t e a c h e r asked c l e a r , d i r e c t , s p e c i f i c q u e s t i o n s . " (McCann 1959, p.109.) 2. " S t i m u l a t i n g and i n v o l v i n g s t u d e n t s . " (Barham 1965.) 3. "Making s t u d e n t s t h i n k and m o t i v a t i n g them." (Jacobson 1966.) A. "Asks t h o u g h t - p r o v o k i n g q u e s t i o n s . " ( B u t l e r and G e i t g e y 1970.) 5. "Encourages s t u d e n t s to t h i n k f o r t h e m s e l v e s . " " S t i m u l a t e s i n t e l l e c t u a l c u r i o s i t y . " (Lowery, Keane and Hyman 1971.) 6. "He i n s p i r e s s t u d e n t s to independent e f f o r t and d e s i r e f o r i n v e s t i g a t i o n . " " H i s encouragement o f s t u d e n t t h i n k i n g was o u t s t a n d i n g . " (Armington, R e i n i k k a and C r e i g h t o n 1972.) 7. "Encourages independent t h i n k i n g and l e a r n i n g . " ( K i k e r 1973.) 8. "Asks t h o u g h t - p r o v o k i n g q u e s t i o n s . " "Encourages s t u d e n t to make d i s c o v e r i e s , g e n e r a l i z a t i o n s . " " F a c i l i t a t e s i n t e r p r e t a t i o n o f a b s t r a c t i d e a s . " (Dixon and Koern e r 1976.) - 6 -How might the above b e h a v i o r s be a c h i e v e d ? How might a n u r s i n g i n s t r u c -t o r ask t h o u g h t - p r o v o k i n g q u e s t i o n s , s t i m u l a t e i n t e l l e c t u a l c u r i o s i t y and encourage s t u d e n t s to make d i s c o v e r i e s ? I t i s p a r t i c u l a r l y i m p o r t a n t t h a t the c l i n i c a l i n s t r u c t o r be a b l e t o a c h i e v e these b e h a v i o r s as she i s r e -s p o n s i b l e f o r e n s u r i n g , not o n l y t h a t s t u d e n t s o b t a i n the r e q u i r e d c l i n -i c a l e x p e r i e n c e s , but a l s o t h a t they a r e a b l e to p l a n and e x e c u t e i n c r e a s -i n g l y complex n u r s i n g c a r e . In o r d e r to n u r s e , the s t u d e n t , i n d e e d any n u r s e , must be a b l e to a s s e s s the p a t i e n t , i d e n t i f y problems, s e t p r i o -r i t i e s , f o r m u l a t e o b j e c t i v e s , implement n u r s i n g measures and e v a l u a t e the e f f e c t i v e n e s s o f those measures. T h i s s e r i e s o f o p e r a t i o n s i s known as the n u r s i n g p r o c e s s . (Bower 1972; Yura and Walsh 1973.) The n u r s i n g p r o c e s s r e q u i r e s h i g h l e v e l s o f c o g n i t i v e thought, namely a n a l y s i s o f the p a t i e n t ' s problem, s y n t h e s i s of a p l a n o f c a r e and e v a l u a t i o n of the c a r e g i v e n . D u r i n g the p o s t - c l i n i c a l c o n f e r e n c e the i n s t r u c t o r and s t u d e n t s engage i n a d i s c u s s i o n , d u r i n g which each s t u d e n t i s e x p e c t e d to t a l k about h e r n u r s i n g problems. The group i s encouraged to c l a r i f y i s s u e s and suggest p o s s i b l e s o l u t i o n s . The w r i t t e n assignment f o r the c l i n i c a l e x p e r i e n c e i s t y p i c a l l y a n u r s i n g c a r e p l a n and a " p r o c e s s . " The l a t t e r i s a w r i t t e n r e c o r d o f the s t e p s the s t u d e n t took i n p r o v i d i n g c a r e and h e r r e a s o n s f o r h e r a c t i o n s . F o r a c l i n i c a l i n s t r u c t o r to e f f e c t i v e l y h e l p s t u d e n t s a c h i e v e the c l i n i c a l o b j e c t i v e s , she must be a b l e to d i r e c t t h e i r t h i n k i n g toward h i g h c o g n i t i v e l e v e l s . In summary, the c l i n i c a l n u r s i n g i n s t r u c t o r i s judged f o r e f f e c t i v e n e s s on s e v e r a l d i m e n s i o n s . One s p e c i f i c d imension i s h e r a b i l i t y to ask t h o u g h t - p r o v o k i n g q u e s t i o n s . In B r i t i s h Columbia, the m a j o r i t y of -7-c l i n i c a l n u r s i n g i n s t r u c t o r s who t e a c h i n community c o l l e g e s and whose job i n c l u d e s t e a c h i n g s t u d e n t s to t h i n k a t h i g h c o g n i t i v e l e v e l s , earned b a c c a l a u r e a t e degrees from programs which o f f e r e d them l i t t l e , i f any, p r e p a r a t i o n f o r t h e i r i n s t r u c t i o n a l r o l e . 1.3 J u s t i f i c a t i o n f o r the Study Teachers have always posed q u e s t i o n s . Perhaps the most famous q u e s t i o n i n g t e a c h e r i s S o c r a t e s who e x t r a c t e d the theorem o f P ythagoras from an i l l i t e r a t e boy. Only r e c e n t l y , however, have r e s e a r c h e r s attempted to s tudy q u e s t i o n i n g t e c h n i q u e s and the r e l a t i o n s h i p between p a t t e r n s and types o f q u e s t i o n s , and l e a r n i n g and c o g n i t i v e thought. ( C l e g g 1971.) " Q u e s t i o n s , when s k i l l f u l l y asked, a s s i s t s t u d e n t s to see r e l a t i o n s h i p s and l i n k the unknown to the known. In a d d i t i o n , q u e s t i o n i n g p e r m i t s s t u d e n t and t e a c h e r to e x p l o r e i d e a s t o g e t h e r . The a r t o f q u e s t i o n i n g , more than any o t h e r s i n g l e t e a c h i n g s k i l l , can a s s i s t the t e a c h e r i n c o n v e y i n g h e r i n t e r e s t , h e r enthusiasm, and her c o n t i n u e d p u r s u i t o f h e r own l e a r n i n g . " (de Tornyay 1971.) Minor (1967) attempted to develop an a r t - s c i e n c e o f q u e s t i o n i n g . She summarized her s u r v e y of the l i t e r a t u r e by the f o l l o w i n g : 1. Q u e s t i o n s , i n t e a c h i n g , a r e s t r a t e g i c a l l y c r i t i c a l . 2. Q u e s t i o n s d i r e c t and f o c u s t h i n k i n g ; s e r v i n g as s t i m u l i - as c l u e s . As avenues to a l l e x p l o r a t i o n , they can be l i m i t e d , l i m i t i n g o r l i m i t l e s s . 3. Q u e s t i o n s may determine the d a t a which s t u d e n t s w i l l seek; whence t h e i r r e s p o n s e s f o l l o w upon the k i n d s o f q u e s t i o n s . In e s s e n c e , q u e s t i o n s h e l p determine the ways i n which s t u d e n t s w i l l seek and o r g a n i z e d a t a . -8-4. Q u e s t i o n s s e r v e as d i a g n o s t i c t o o l s e n a b l i n g the t e a c h e r to a s s e s s the n a t u r e and s i z e o f the h o l e s i n the s t u d e n t ' s s i e v e o f knowledge, (pp.53-54.) These s t a t e m e n t s , t o g e t h e r w i t h those common elements e x t r a c t e d from the s t u d i e s o f s t u d e n t p e r c e p t i o n s of e f f e c t i v e t e a c h i n g , p r o v i d e c o n s i d e r -a b l e s u p p o r t f o r the n o t i o n t h a t the a c q u i s i t i o n o f q u e s t i o n i n g s k i l l s i s a d e s i r a b l e g o a l f o r n u r s i n g i n s t r u c t o r s . S e v e r a l s t u d i e s have been conducted which show t h a t t e a c h e r s l a c k q u e s t i o n i n g s k i l l s . (Barnes 1976; D a v i s and T i n s l e y 1967; S c h o l d r a and Q u i r i n g 1973.) The b a s i c approach i n these s t u d i e s has been to c l a s s -i f y q u e s t i o n s i n terms o f the degree o f c o g n i t i v e a c t i v i t y they demand. As a measure o f the l e v e l o f c o g n i t i v e a c t i v i t y , the Taxonomy of E d u c a t i o n a l  O b j e c t i v e s , e d i t e d by Benjamin Bloom (1956), has proved to be a u s e f u l system. Bloom and h i s c o l l e a g u e s c o n c e i v e d the c o g n i t i v e domain as p o s s e s s -i n g s i x d i v i s i o n s a r r a n g e d i n a h i e r a r c h y . The lowest d i v i s i o n o f the h i e r -a r c h y i s Knowledge, f o l l o w e d by Comprehension, A p p l i c a t i o n , A n a l y s i s , Syn-t h e s i s and u l t i m a t e l y , E v a l u a t i o n . U s i n g t h i s system, the above r e s e a r c h e r s c l a s s i f i e d q u e s t i o n s as "low l e v e l " i f they a d d r e s s e d the s t u d e n t s ' a b i l i t y t o r e c a l l , comprehend o r a p p l y knowledge and " h i g h l e v e l " i f they r e q u i r e d the c o g n i t i v e s k i l l s of a n a l y s i s , s y n t h e s i s o r e v a l u a t i o n to answer the q u e s t i o n . Barnes (1976) found t h a t 82.33% o f q u e s t i o n s posed by 40 c o l l e g e p r o f e s s o r s t e a c h i n g i n f o u r i n s t i t u t i o n s a d d r e s s e d the l o w e s t c o g n i t i v e l e v e l . D a vis and T i n s l e y (1967) showed t h a t b o t h t e a c h e r s and s t u d e n t s asked more Knowledge q u e s t i o n s than a l l o t h e r c a t e g o r i e s combined; f u r t h e r -more, they found t h a t the l e v e l o f s t u d e n t q u e s t i o n s d i r e c t e d toward the t e a c h e r c o r r e l a t e d 0.9 w i t h the l e v e l of q u e s t i o n s asked by the t e a c h e r . - 9 -I f the t e a c h e r posed q u e s t i o n s a t the a n a l y s i s l e v e l , s t u d e n t s would a l s o ask q u e s t i o n s a t the a n a l y s i s l e v e l . I f the purpose o f p o s t - c l i n i c a l c o n f e r e n c e s i s to h e l p s t u d e n t s implement the n u r s i n g p r o c e s s , then the type of q u e s t i o n s asked s h o u l d r e f l e c t the a n a l y s i s , s y n t h e s i s and e v a l u a t i o n s k i l l s r e q u i r e d to do t h i s . However, S c h o l d r a and Q u i r i n g (1973) a n a l y s e d 617 q u e s t i o n s asked by i n -s t r u c t o r s and s t u d e n t s i n a b a c c a l a u r e a t e n u r s i n g program d u r i n g p o s t -c l i n i c a l c o n f e r e n c e s and found t h a t o n l y s i x were d i r e c t e d toward the h i g h e r c o g n i t i v e l e v e l s . P r e l i m i n a r y r e v i e w of c l i n i c a l c o n f e r e n c e s con-ducted by i n s t r u c t o r s who t e a c h i n community c o l l e g e s i n B r i t i s h Columbia has produced s i m i l a r r e s u l t s . There i s s u b s t a n t i a l e v i d e n c e , t h e r e f o r e , t h a t c l i n i c a l n u r s i n g i n s t r u c t o r s need t r a i n i n g i n q u e s t i o n i n g s k i l l s . How might t h i s t r a i n i n g be p r o v i d e d ? The f o l l o w i n g a l t e r n a t i v e s may be c o n s i d e r e d : 1. I n f o r m a t i o n c o u l d be d i s t r i b u t e d a l e r t i n g the i n s t r u c t o r s to t h e i r need to develop q u e s t i o n i n g s k i l l s and an approp-r i a t e b i b l i o g r a p h y p r o v i d e d . Even assuming the p r e s e n c e o f m o t i v a t i o n , t h i s method v i o l a t e s the l e a r n i n g p r i n c i p l e s o f engaging the l e a r n e r i n an a c t i v e way, and p r o v i d i n g feedback — two n e c e s s a r y c o n d i t i o n s f o r the development of any s k i l l . 2. Workshops c o u l d be o f f e r e d i n a l l community c o l l e g e s . T h i s method has m e r i t , but c o s t , time and l a c k of p e r s o n n e l make i t i m p r a c t i c a l . -10-3. A s e l f - i n s t r u c t i o n a l module c o u l d be p r e p a r e d and p r o -s v i d e d to a l l n u r s i n g i n s t r u c t o r s who e x p r e s s a d e s i r e to improve t h e i r q u e s t i o n i n g t e c h n i q u e s . I f the module m o t i v a t e d the i n s t r u c t o r t o improve, i n v o l v e d h e r a c t i v e l y i n the l e a r n i n g p r o c e s s , p r o v i d e d h e r w i t h feedback, and was r e l a t i v e l y i n e x p e n s i v e , t h i s method would c l e a r l y be the method o f c h o i c e . 1.4 D e f i n i t i o n o f Terms C l i n i c a l a r e a : A h o s p i t a l ward, community h e a l t h c l i n i c , d o c t o r ' s o f f i c e o r any o t h e r a r e a s e r v i n g p a t i e n t s and i n which n u r s i n g s t u d e n t s p r a c t i c e s k i l l s l e a r n e d i n the c l a s s r o o m . C l i n i c a l n u r s i n g i n s t r u c t o r ( i n s t r u c t o r ) : A n u r s i n g i n s t r u c t o r who t e a c h e s , observes and e v a l u a t e s the s t u d e n t i n the c l i n i c a l a r e a where the s t u d e n t i s g i v e n a s p e c i f i c p a t i e n t assignment to p r o v i d e d i r e c t p a t i e n t c a r e . P o s t - c l i n i c a l c o n f e r e n c e : A d i s c u s s i o n conducted by the i n s t r u c t o r w i t h a l l s t u d e n t s f o r whom she has been r e s p o n s i b l e , f o l l o w i n g the e x p e r i e n c e i n the c l i n i c a l a r e a . Module: A s e l f - c o n t a i n e d , independent u n i t o f a p l a n n e d s e r i e s of l e a r n -i n g a c t i v i t i e s d e s i g n e d t o h e l p the i n s t r u c t o r a c c o m p l i s h c e r t a i n w e l l -d e f i n e d l e a r n i n g o b j e c t i v e s . -11-High l e v e l q u e s t i o n s : F o r the purpose of t h i s s t u d y , h i g h l e v e l ques-t i o n s a r e d e f i n e d as those q u e s t i o n s which address the upper f o u r l e v e l s o f Bloom's Taxonomy of e d u c a t i o n a l o b j e c t i v e s - a p p l i c a t i o n , a n a l y s i s , s y n t h e s i s and e v a l u a t i o n . Low l e v e l q u e s t i o n s : F o r the purpose o f t h i s s t u d y , low l e v e l ques-t i o n s a r e d e f i n e d as those q u e s t i o n s which address the lower two l e v e l s o f Bloom's Taxonomy of e d u c a t i o n a l o b j e c t i v e s - knowledge and comprehen-s i o n . S t udent: A n u r s i n g s t u d e n t e n r o l l e d i n a two-year c o l l e g e n u r s i n g program p r e p a r a t o r y to e a r n i n g a diploma i n n u r s i n g and n u r s e r e g i s t r a t i o n . C l i n i c a l o b j e c t i v e s : L e a r n i n g o b j e c t i v e s to be a c h i e v e d by the s t u d e n t i n the c l i n i c a l a r e a . -12-CHAPTER I I  Review o f S e l e c t e d R e l a t e d L i t e r a t u r e  I n t r o d u c t i o n In t h i s r e v i e w of r e l a t e d l i t e r a t u r e the f i n d i n g s which are p e r t i n e n t t o t h i s s t u d y a r e d e s c r i b e d . The review i s p r e s e n t e d under the headings C l i n i c a l C o n f e r e n c e s , C l a s s i f i c a t i o n o f Q u e s t i o n s , Q u e s t i o n -i n g B e h a v i o r o f T e a c h e r s , E f f e c t o f Q u e s t i o n i n g on Student B e h a v i o r and I n s t r u c t i o n i n Q u e s t i o n i n g . 2.1 C l i n i c a l C o n f e r e n c e s "The c l i n i c a l n u r s i n g c o n f e r e n c e has come to be r e c o g n i z e d as a p i v o t a l component of the t o t a l t e a c h i n g p l a n i n c l i n i c a l n u r s i n g . " (Schweer and Gebbie 1976, p.118.) These a u t h o r s see the purpose o f the c o n f e r e n c e as a p r o b l e m - s o l v i n g a c t i v i t y d u r i n g which s t u d e n t s determine ways of p r o v i d i n g n u r s i n g c a r e . A l t h o u g h the d i s c u s s i o n s a r i s e from the o b j e c t i v e s o f the c l i n i c a l e x p e r i e n c e , the p a t i e n t s and the s t u d e n t s , Schweer and Gebbie s t r e s s the need f o r s p o n t a n e i t y i n a l l o w i n g s t u d e n t s to d e a l w i t h "now problems" r a t h e r than a f i x e d p l a n o f t o p i c s . Appa-r e n t l y , the c r e a t i v e c l i n i c a l t e a c h e r i s a b l e to b r i d g e t h i s c l e f t be-tween p l a n n i n g and s p o n t a n e i t y and p r o v i d e "a l e a r n i n g environment t h a t f o s t e r s o p p o r t u n i t i e s f o r s t u d e n t s to t h i n k through c h a l l e n g i n g and -13-w o r t h w h i l e problems, a l l o w i n g f o r t h e i r c o m p l e t i o n and e v a l u a t i o n w h i l e s i m u l t a n e o u s l y l e a r n i n g new s u b j e c t m a t t e r " (Schweer and Gebbie 1976, p.119). Matheney (1969) i s more s p e c i f i c . She l i s t s the purposes o f a p o s t - c l i n i c a l c o n f e r e n c e : 1. To a n a l y z e the c l i n i c a l e x p e r i e n c e . 2. To c l a r i f y r e l a t i o n s h i p s between t h e o r y and p r a c t i c e . 3. To develop g e n e r a l i z a t i o n s and g u i d e l i n e s i n p r o v i d i n g n u r s i n g c a r e . 4. To c l a r i f y b oth t h i n k i n g and f e e l i n g . 5. To keep the f o c u s on p a t i e n t s as p e o p l e . 6. To r e i n f o r c e p r o c e s s l e a r n i n g . In g i v i n g a d v i c e on how to d i r e c t a c l i n i c a l c o n f e r e n c e , Matheney s t a t e s t h a t a l l s t u d e n t r e p o r t s must be a n a l y s e d , t e s t e d f o r a p p l i c a b i l i t y and e v a l u a t e d ; they must not be s i m p l e d e s c r i p t i v e r e p o r t s o f what o c c u r r e d . Q u e s t i o n s must be c o n t i n u a l l y asked by the i n s t r u c t o r t o h e l p the s t u d e n t see meaning i n her e x p e r i e n c e s . H e i d g e r k e n (1965) d i f f e r e n t i a t e s between a "problem" and a " p r o b l e m - s o l v i n g " a c t i v i t y . Emphasis on the l a t t e r a c t i v i t y i n n u r s i n g has r e s u l t e d i n s t u d e n t s who r e c i t e "an e n c y c l o p a e d i c enumeration o f d a t a " (p.442) and t h i n k they a r e engaged i n the p r o c e s s o f problem-s o l v i n g . In her a n a l y s i s o f why s t u d e n t s may appear to be u s i n g a problem-s o l v i n g approach, when i n f a c t they a r e merely l i s t i n g d a t a and d e s c r i b i n g -14-the t a s k s they performed, she s t r e s s e s the need f o r q u e s t i o n i n g by the i n s t r u c t o r i n o r d e r to promote t r u e p r o b l e m - s o l v i n g s k i l l s . These e n t a i l i d e n t i f y i n g , d e f i n i n g and a n a l y z i n g a problem, c o n s i d e r i n g a l t e r n a t i v e s o l u t i o n s , c h o o s i n g a s o l u t i o n and e v a l u a t i n g i t s e f f e c t . H i l l (1967) i n v e s t i g a t e d a number of c l i n i c a l c o n f e r e n c e s i n a b a c c a l a u r e a t e n u r s i n g program. She s a i d t h a t the purpose o f the c l i n i c a l c o n f e r e n c e was to s t i m u l a t e the s t u d e n t t o : 1) seek the n e c e s s a r y know-ledg e from v a r i o u s s o u r c e s ; 2) examine the s c i e n t i f i c b a s i s on which she made her n u r s i n g d i a g n o s i s and p l a n n e d a p p r o p r i a t e i n t e r v e n t i o n s ; 3) e v a l u a t e the response o f the p a t i e n t and f a m i l y to n u r s i n g and m e d i c a l c a r e . While n u r s i n g e d u c a t o r s c o n s i d e r c l i n i c a l c o n f e r e n c e s to be an e s s e n t i a l component i n the development o f h i g h e r l e v e l o b j e c t i v e s f o r s t u d e n t s , S c h o l d r a (1972, p.4) n o t e s t h a t " F a c t o r s i n the c l i n i c a l c on-f e r e n c e (and i n t e r v i e w ) which i n f l u e n c e achievement of the o b j e c t i v e s of c l i n i c a l e x p e r i e n c e have not been i n v e s t i g a t e d . " The purposes of p o s t - c l i n i c a l c o n f e r e n c e s have been d e s c r i b e d to show t h a t s t u d e n t s must use h i g h l e v e l s o f c o g n i t i v e t h i n k i n g i f they are to meet the o b j e c t i v e s of the c l i n i c a l e x p e r i e n c e . The g e n e r a l con-c l u s i o n s a r e : 1. Q u e s t i o n i n g i s a v i t a l s k i l l needed by i n s t r u c t o r s i f they a r e to a s s i s t s t u d e n t s to r e a c h these h i g h l e v e l s of thought. -15-2. Most a u t h o r s o f l i t e r a t u r e d i r e c t e d toward n u r s i n g i n s t r u c t o r s appear to assume t h a t q u e s t i o n i n g s k i l l s a r e i n h e r e n t i n the i n s t r u c t o r ; an e x h o r t a t i o n to "encourage c r i t i c a l t h i n k i n g " w i l l s u f f i c e . The next s e c t i o n o f t h i s c h a p t e r w i l l d e s c r i b e q u e s t i o n s c l a s s -i f i c a t i o n systems t h a t have been d e v e l o p e d d u r i n g r e s e a r c h on q u e s t i o n i n g . 2.2 C l a s s i f i c a t i o n o f Q u e s t i o n s S y s t e m a t i c o b s e r v a t i o n o f c l a s s r o o m b e h a v i o r i s a c o m p a r a t i v e l y r e c e n t r e s e a r c h a c t i v i t y (Dunkin and B i d d l e 1974). With the development of c o d i n g i n s t r u m e n t s such as the F l a n d e r s I n t e r a c t i o n A n a l y s i s Category system ( F l a n d e r s 1970), q u e s t i o n s and respo n s e s become f o c i f o r i n q u i r y . P a r a l l e l i n g t h i s development was an i n t e r e s t i n c o g n i t i v e p r o c e s s e s . The Bloom e_t a l . (1956) Taxonomy o f E d u c a t i o n a l O b j e c t i v e s became the b a s i s , n ot o n l y f o r s t a t i n g o b j e c t i v e s , but f o r c l a s s i f y i n g q u e s t i o n s . Sanders (1966) took the f i r s t s t e p from the Taxonomy to a c l a s s i f i c a t i o n scheme f o r q u e s t i o n s d e s i g n e d to f o s t e r the i n c r e a s i n g h i g h o r d e r c o g n i t i v e o p e r a t i o n s d e s c r i b e d i n the Taxonomy. In o r d e r to q u a n t i f y r e s e a r c h i n t o the types o f q u e s t i o n s asked by t e a c h e r s , many c l a s s i f i c a t i o n systems have been d e v e l o p e d . G a l l (1970) l i s t s r e f e r e n c e s f o r e l e v e n such systems. S c h o l d r a (1972, p.13) reviewed G a l l ' s l i s t p l u s an a d d i t i o n a l t h r e e systems and R i e g l e (1976) i d e n t i f i e s - 1 6 -21 c l a s s i f i c a t i o n systems. However, as R i e g l e p o i n t s o u t , most o f t h e s e systems have been devel o p e d f o r s p e c i f i c s u b j e c t m a t t e r and have l i m i t e d g e n e r a l a p p l i c a t i o n . F o r example, Friedman (1974) adapted Bloom's h i e r -a r c h i c a l model i n t o a system to a l l o w t e a c h e r s of geometry to code and a n a l y s e t h e i r q u e s t i o n s . The r u l e s and examples he g i v e s a r e of l i t t l e use to o t h e r than m a t h e m a t i c i a n s . Two c l a s s i f i c a t i o n schemes, b o t h based on Bloom's Taxonomy, have g e n e r a l a p p l i c a t i o n . In a study d e s i g n e d to examine q u e s t i o n s asked by t e a c h e r s and t h e i r s t u d e n t s , D a v i s and T i n s l e y (1967) d e v e l o p e d the Teacher P u p i l Q u e s t i o n I n v e n t o r y . The n i n e c a t e g o r i e s of the T.P.Q.I. are 1) memory, 2) i n t e r p r e t a t i o n , 3) t r a n s l a t i o n , 4) a p p l i c a t i o n , 5) a n a l y s i s , 6) s y n t h e s i s , 7) e v a l u a t i o n , 8) a f f e c t i v i t y , 9) p r o c e d u r e . The f i r s t e i g h t c a t e g o r i e s d e s c r i b e the a c t i v i t y e x p e c t e d o f the s t u d e n t i n o r d e r to answer the q u e s t i o n . F o r example, s y n t h e s i s r e q u i r e s t h a t "the one q u e s t i o n e d s u g g e s t s answers to a problem t h a t i s o r i g i n a l , s p e c u l a t i v e , o r c r e a t i v e . " The p r o c e d u r e c a t e g o r y codes q u e s t i o n s r e -l a t e d to c l a s s r o o m o r g a n i z a t i o n . Manson and C l e g g (1970) d e s i g n e d a form to e n a b l e t e a c h e r s to t a l l y the q u e s t i o n s they asked. Based on Bloom's Taxonomy, i t re-names the s i x c a t e g o r i e s as Remembering f o r Knowledge, U n d e r s t a n d i n g f o r Comprehension, S o l v i n g f o r A p p l i c a t i o n , A n a l y z i n g f o r A n a l y s i s , C r e a t i n g f o r S y n t h e s i s , J u d g i n g f o r E v a l u a t i o n . The form i n c l u d e s a summary of the e x p e c t e d c o g n i t i v e a c t i v i t y r e q u i r e d o f the s t u d e n t a t each l e v e l , and a l i s t o f key concepts f o r each l e v e l . In a d d i t i o n , samples of phrases and q u e s t i o n s t h a t address each l e v e l a r e g i v e n . -17-As G a l l (1970) s a y s , " I t appears t h a t Bloom's Taxonomy b e s t r e p r e s e n t s the commonalities t h a t e x i s t among the systems." However, he i d e n t i f i e s c e r t a i n l i m i t a t i o n s when the Taxonomy i s used e x c l u s i v e l y : 1. P r o b i n g q u e s t i o n s used t o cue s t u d e n t s to improve an i n i t i a l weak response are w o r t h w h i l e q u e s t i o n s but a r e d i f f i c u l t to code u s i n g the s i x c a t e g o r i e s . 2. Bloom's system c l a s s i f i e s q u e s t i o n s which are d i r e c t e d at o n l y a few of the e d u c a t i o n a l o b j e c t i v e s . Q u e s t i o n s r e q u i r i n g an a f f e c t i v e response are not i n c l u d e d . F o r example, "What was your r e a c t i o n when the p a t i e n t t o l d you he had gonorrhaea?" c o u l d not be coded i n Bloom's system. 3. P r o c e d u r a l and r h e t o r i c a l q u e s t i o n s a r e not a c c o u n t e d f o r . 4. The c o g n i t i v e p r o c e s s e s i n which the s t u d e n t engages a r e i n f e r e n t i a l c o n s t r u c t s and cannot be o b s e r v e d d i r e c t l y . Thus, a q u e s t i o n such as, "What a r e some s i m i l a r i t i e s between the n u r s i n g c a r e r e q u i r e d f o r t h i s c h i l d and t h a t r e q u i r e d f o r t h i s 8 0 - y e a r - o l d man," may s t i m u l a t e c r i t i c a l t h i n k i n g , o r , may e l i c i t r e c a l l o f s i m i l a r i t i e s l i s t e d i n a t e x t . In an e f f o r t t o overcome t h e s e l i m i t a t i o n s , R i e g l e (1976) su g g e s t s a scheme based on John W i l s o n ' s Statement C l a s s i f i c a t i o n System. T h i s scheme d i v i d e s a l l q u e s t i o n s i n t o two c a t e g o r i e s - i n t e r r o g a t i v e q u e s t i o n s and r h e t o r i c a l q u e s t i o n s . The i n t e r r o g a t i v e q u e s t i o n c a t e g o r y has f i v e major s u b d i v i s i o n s - e m p i r i c a l , a n a l y t i c , v a l u e , p r e f e r e n c e and m e t a p h y s i c a l . The r h e t o r i c a l q u e s t i o n c a t e g o r y i s s u b d i v i d e d i n t o i m p e r a t i v e , d e c l a r a t i v e and e x c l a m a t o r y . Many advantages of t h i s system are i d e n t i f i e d , p a r t i c u l a r l y the f a c t t h a t q u e s t i o n s a r e c a t e g o r i z e d a c c o r d i n g to semantic cues w i t h i n the q u e s t i o n and not the c o g n i t i v e a c t i v i t y r e q u i r e d to answer them. T h i s system i s a p p e a l i n g b u t , as R i e g l e p o i n t s o u t , i t i s an o u t l i n e . F u r t h e r c o n c e p t u a l r e f i n e m e n t and -18-e m p i r i c a l t e s t i n g f o r r e l i a b i l i t y and v a l i d i t y i s r e q u i r e d b e f o r e i t can be used. T h i s s e c t i o n o f the re v i e w has d e s c r i b e d the development o f systems d e s i g n e d to c l a s s i f y q u e s t i o n s , p a r t i c u l a r l y those based on Bloom's Taxonomy. The g e n e r a l c o n c l u s i o n s a r e : 1. At p r e s e n t , a c l a s s i f i c a t i o n system based on Bloom's Taxonomy i s the system o f c h o i c e . 2. The l i m i t a t i o n s o f u s i n g a system based on Bloom's Taxonomy must be taken i n t o account when c o d i n g q u e s t i o n s asked by i n s t r u c t o r s d u r i n g the e x p e r i m e n t a l phase o f t h i s study. The n e x t s e c t i o n o f t h i s c h a p t e r p r e s e n t s a re v i e w o f r e s e a r c h undertaken to d e s c r i b e the q u e s t i o n i n g b e h a v i o r o f t e a c h e r s . 2.3 Q u e s t i o n i n g B e h a v i o r o f Teachers A l t h o u g h t e a c h e r s agree t h a t an e d u c a t i o n a l g o a l i s to f o s t e r c r i t i c a l t h i n k i n g , r e s e a r c h spanning more than f i f t y y e a r s demonstrates t h a t the m a j o r i t y o f t e a c h e r s ' q u e s t i o n s r e q u i r e r e c a l l o f f a c t s as a r e s p o n s e . An e a r l y study by Stevens (1912) showed t h a t f o u r - f i f t h s o f s t u d e n t - t e a c h e r i n t e r a c t i o n comprised q u e s t i o n and answer d i a l o g u e and of the numerous q u e s t i o n s asked, few prompted " t h o u g h t . " A l t h o u g h the days o f r e c i t a t i o n s and d r i l l s a r e o v e r , D a v i s and T i n s l e y (1967), -19-Godbold (1968), S c h o l d r a and Q u i r i n g (1973) and Barnes (1976) have demonstrated t h a t the l e v e l o f q u e s t i o n s posed i s unchanged. The study by D a v i s and T i n s l e y (1967) sought to determine the range o f c o g n i t i v e o b j e c t i v e s e v i d e n t i n q u e s t i o n s asked by s t u d e n t t e a c h e r s and t h e i r p u p i l s . U s i n g the Teacher P u p i l Q u e s t i o n I n v e n t o r y d e s c r i b e d e a r l i e r , o b s e r v e r s a n a l y s e d q u e s t i o n s asked d u r i n g a l t e r n a t e f i v e minute segments o f t h i r t y minute p e r i o d s o f c l a s s r o o m t e a c h i n g . A n a l y s i s o f the d a t a i n d i c a t e d t h a t o f 2,143 q u e s t i o n s , 1,313 were a t the memory l e v e l , 187 were t r a n s l a t i o n , and 391 were i n t e r p r e t a t i o n . Q u e s t i o n s i n the a p p l i c a t i o n , a n a l y s i s , s y n t h e s i s and e v a l u a t i o n l e v e l s comprised o n l y 11.76% of the t o t a l . The r e m a i n i n g q u e s t i o n s d e a l t w i t h a f f e c t i v e o r p r o c e d u r a l i s s u e s . The a u t h o r s c o n c l u d e d , " S p e c i f i c under-s t a n d i n g s and s k i l l s o f c l a s s r o o m q u e s t i o n i n g and the purposes of ques-t i o n s need major a t t e n t i o n i n the p r e - s e r v i c e and i n - s e r v i c e e d u c a t i o n o f t e a c h e r s . " Godbold (1968) d e s i g n e d a stu d y to determine whether the l e v e l o f q u e s t i o n s asked v a r i e d w i t h the o r g a n i z a t i o n s e t t i n g and l e n g t h o f t e a c h i n g e x p e r i e n c e . S i x t e e n elementary and s i x t e e n secondary s c h o o l t e a c h e r s were s e l e c t e d and d i v i d e d i n t o groups a c c o r d i n g to l e n g t h o f t e a c h i n g e x p e r i e n c e . Data were c o l l e c t e d from f i f t y - f i v e minute a u d i o -tape r e c o r d i n g s o f d i s c u s s i o n s l e d by the s u b j e c t s . Q u e s t i o n s were c l a s s i f i e d a c c o r d i n g to a system based on Bloom's Taxonomy. The r e s e a r c h e r c o n c l u d e d t h a t though the more e x p e r i e n c e d t e a c h e r s asked more q u e s t i o n s , a l l groups asked more memory q u e s t i o n s than any o t h e r l e v e l . - 2 0 -S c h o l d r a and Q u i r i n g (1973) conducted a d e s c r i p t i v e s t u d y to i n v e s t i g a t e the k i n d s o f q u e s t i o n s asked by n u r s i n g i n s t r u c t o r s and s t u d e n t s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s of a b a c c a l a u r e a t e program. A t o t a l o f 22 c o n f e r e n c e s a v e r a g i n g 63 minutes each was a u d i o t a p e d . Q u e s t i o n s were a n a l y s e d u s i n g the c l a s s i f i c a t i o n system d e s i g n e d by Manson and C l e g g (1970). Data a n a l y s i s was based on 617 q u e s t i o n s , 38% of which were asked by s t u d e n t s . N u r s i n g i n s t r u c t o r s and s t u d e n t s asked 508 remembering, 59 comprehension and 44 s o l v i n g q u e s t i o n s compared w i t h s i x h i g h e r l e v e l q u e s t i o n s . ( H i g h e r l e v e l , i n t h i s s t u d y , was determined to be a n a l y s i s , s y n t h e s i s and e v a l u a t i o n . ) As an i s s u e , t h ese r e s e a r c h e r s asked, "Are n u r s i n g i n s t r u c t o r s who ask l o w - l e v e l q u e s t i o n s j u s t i f i e d i n e x p e c t i n g s t u d e n t s to develop h i g h - l e v e l s k i l l s such as those i n v o l v e d i n the p r o c e s s of a n a l y z i n g , s y n t h e s i z i n g and e v a l u a t i n g ? " More r e c e n t l y , Barnes (1976) d e s c r i b e d the q u e s t i o n i n g b e h a v i o r o f 40 p r o f e s s o r s among f o u r i n s t i t u t i o n s . She a u d i o t a p e d t e a c h e r s and a n a l y s e d s e v e r a l t e a c h i n g b e h a v i o r s i n c l u d i n g q u e s t i o n i n g . U s i n g a c l a s s -i f i c a t i o n system based on Bloom's Taxonomy she found t h a t 82.33% of q u e s t i o n s a d d r e s s e d the l o w e s t c o g n i t i v e l e v e l . F u r t h e r m o r e , p r o f e s s o r s i n the mathematics, s c i e n c e and e n g i n e e r i n g d i s c i p l i n e s asked more low l e v e l q u e s t i o n s than those i n the h u m a n i t i e s , s o c i a l s c i e n c e s and a r t s . C l e g g et^ a l . (1969) i n t r o d u c e d the concept of the "grammar o f the i n t e r r o g a t i v e " as a v a r i a b l e c o n t r i b u t i n g to the low l e v e l o f q u e s t i o n s asked by t e a c h e r s . While a n a l y s i n g tapes f o r a s t u d y , r a t e r s n o t i c e d a f r e q u e n t r e p e t i t i o n o f those q u e s t i o n words a p p r o p r i a t e f o r the knowledge -21-and comprehension c a t e g o r i e s o f q u e s t i o n s b u t few o f any o t h e r l e v e l . These words form the grammar o f the i n t e r r o g a t i v e and a r e common words i n a t e a c h e r ' s v o c a b u l a r y t h a t p r o v i d e cues to the s t u d e n t about the type o f answer r e q u i r e d . In the appendix to t h e i r paper they l i s t t y p i c a l q u e s t i o n words t h a t may be l e a r n e d and used f o r each l e v e l . T h i s s e c t i o n has d e s c r i b e d r e s e a r c h which shows t h a t most q u e s t i o n s asked by t e a c h e r s r e q u i r e no more than r e c a l l o f f a c t s by s t u d e n t s . The g e n e r a l c o n c l u s i o n s a r e : 1. Teachers ask a c o n s i d e r a b l e number of q u e s t i o n s d u r i n g t h e i r i n t e r c h a n g e w i t h s t u d e n t s . 2. Of the q u e s t i o n s asked by t e a c h e r s , the m a j o r i t y a d d r e s s the l o w e s t l e v e l s o f the c o g n i t i v e domain. 3. One r e a s o n f o r the preponderance o f low l e v e l q u e s t i o n s asked by t e a c h e r s may be t h a t t y p i c a l q u e s t i o n words a t the h i g h e r l e v e l s a r e not g e n e r a l s t o c k i n a t e a c h e r ' s v o c a b u l a r y . A c c o u n t s o f s t u d i e s d e s c r i b i n g the e f f e c t s o f q u e s t i o n s on s t u d e n t b e h a v i o r comprise the ne x t d i v i s i o n o f t h i s review. 2.4 E f f e c t o f Q u e s t i o n i n g on Student B e h a v i o r A t e a c h e r ' s q u e s t i o n , r e g a r d l e s s o f how w e l l i t i s worded, i s of l i t t l e v a l u e i f i t has no e f f e c t on s t u d e n t b e h a v i o r . Review of -22-r e s e a r c h i n v e s t i g a t i n g the e f f e c t of q u e s t i o n i n g on s t u d e n t s w i l l be c o n s i d e r e d i n terms of the e f f e c t o f t e a c h e r q u e s t i o n s on: 1. s t u d e n t r e s p o n s e , 2. the l e v e l of s t u d e n t q u e s t i o n s , 3. o t h e r s t u d e n t outcomes. C o l e and W i l l i a m s (1973) examined a c r o s s s e c t i o n of c l a s s r o o m v e r b a l i n t e r a c t i o n i n o r d e r t o e x p l o r e the r e l a t i o n s h i p s between t e a c h e r q u e s t i o n s and p u p i l r e s p o n s e s . Data were g a t h e r e d by a u d i o t a p e d u r i n g p o r t i o n s o f l e s s o n s conducted by e i g h t elementary s c h o o l t e a c h e r s . In a l l , 129 p a i r e d o b s e r v a t i o n s o f q u e s t i o n and response were c o l l e c t e d and a n a l y s e d f o r the c o g n i t i v e l e v e l , l e n g t h and s y n t a x of p u p i l r e s p o n s e s and f o r the c o g n i t i v e l e v e l o f t e a c h e r q u e s t i o n s . The f i n d i n g s s u g g e s t e d t h a t the c o g n i t i v e l e v e l , l e n g t h and s y n t a x o f p u p i l r e s p o n s e s were con-t i n g e n t upon the c o g n i t i v e l e v e l o f q u e s t i o n s asked. For example, a q u e s t i o n d i r e c t e d toward the memory l e v e l e l i c i t e d a r e sponse o f one to t h r e e words i n the form of a word or p h r a s e , whereas a q u e s t i o n demanding d i v e r g e n t t h i n k i n g e l i c i t e d t e n o r more words i n the form o f a compound sen t e n c e o r m u l t i p l e s e n t e n c e s . A r n o l d , Atwood, and Rogers (1973) conducted a s i m i l a r s t u d y to the one above but i n c l u d e d the v a r i a b l e " l a p s e t i m e , " i . e . , the time l a p s i n g between q u e s t i o n and response. They found a s i g n i f i c a n t r e l a t i o n -s h i p between the l e v e l o f q u e s t i o n posed and the l e v e l o f response and no r e l a t i o n s h i p between l a p s e time and q u e s t i o n l e v e l o r response l e v e l . The mean l a p s e time was 1.9 seconds. These f i n d i n g s show t h a t , d e s p i t e - 2 3 -the more s o p h i s t i c a t e d c o g n i t i v e p r o c e s s e s r e q u i r e d to answer a h i g h l e v e l q u e s t i o n , p u p i l s were not a l l o w e d a c o r r e s p o n d i n g i n c r e a s e i n time to answer a h i g h l e v e l q u e s t i o n . Perhaps s t u d e n t s would demonstrate h i g h e r c o g n i t i v e t h i n k i n g i f they were g i v e n time to complete the p r o c e s s b e f o r e the t e a c h e r i n t e r j e c t e d w i t h the answer or a p r o b i n g q u e s t i o n . D a v i s and T i n s l e y (1967) a n a l y s e d the l e v e l o f q u e s t i o n s asked by s t u d e n t t e a c h e r s and the l e v e l o f q u e s t i o n s asked by t h e i r p u p i l s i n a study d e s i g n e d to determine the c o g n i t i v e o b j e c t i v e s m a n i f e s t i n s e c o n -dary s c h o o l s o c i a l s t u d i e s c l a s s r o o m s . U s i n g the T.P.Q.I. d e s c r i b e d e a r l i e r , they o b t a i n e d the medians f o r each l e v e l o f q u e s t i o n asked by t e a c h e r s and by s t u d e n t s . C o r r e l a t i o n between those medians was s i g n i f -i c a n t l y h i g h ; r = 0.9. These r e s u l t s were s u p p o r t e d by Johns (1968). U s i n g F l a n d e r s I n t e r a c t i o n A n a l y s i s C a t e g o r y system ( F l a n d e r s 1970), s t u d e n t - t e a c h e r i n t e r a c t i o n s were coded i n matched h i g h - s c h o o l E n g l i s h c l a s s e s . The purpose o f the study was to determine the r e l a t i o n s h i p between the i n c i d e n c e o f t h o u g h t - p r o v o k i n g q u e s t i o n s by s t u d e n t s and the i n c i d e n c e o f t h o u g h t - p r o v o k i n g q u e s t i o n s and statements by t e a c h e r s . The f i n d i n g s of the two experiments above had i m p l i c a t i o n s f o r t h i s study which i n v e s t i g a t e d the r e l a t i o n s h i p between the l e v e l o f q u e s t i o n s asked by n u r s i n g i n s t r u c t o r s and the l e v e l o f q u e s t i o n s posed by t h e i r s t u d e n t s . A much c i t e d study i s one conducted by Hunkins (1968). Students r e a d a s o c i a l s t u d i e s t e x t supplemented by q u e s t i o n s h e e t s employing -24-a n a l y s i s and e v a l u a t i o n q u e s t i o n s f o r the e x p e r i m e n t a l group and know-le d g e q u e s t i o n s f o r the c o n t r o l group. Achievement was measured by a 42-item m u l t i p l e - c h o i c e t e s t w i t h items r e p r e s e n t i n g each l e v e l o f Bloom's Taxonomy. Those p u p i l s who had used the h i g h l e v e l q u e s t i o n s h e e t s s c o r e d s i g n i f i c a n t l y h i g h e r than those who had r e c e i v e d knowledge l e v e l q u e s t i o n s h e e t s . However, b e t t e r r e a d e r s a c h i e v e d h i g h e r on a l l s c o r e s than d i d p o o r e r r e a d e r s and Hunkins c o n c l u d e s t h a t "whether one can handle h i g h l e v e l q u e s t i o n s i s r e l a t e d t o how w e l l one can r e a d . The h i g h e r l e v e l q u e s t i o n s u s u a l l y were more i n v o l v e d w i t h r e g a r d to w ording than were the knowledge q u e s t i o n s . " T h i s f i n d i n g has i m p l i c a t i o n s f o r n u r s i n g i n s t r u c t o r s i n B r i t i s h Columbia who a r e f r e q u e n t l y r e q u i r e d t o t e a c h s t u d e n t s whose f i r s t language i s not E n g l i s h . R e s u l t s of a study by Q u i r i n g (1971) d i f f e r from those of Hunkins (1968). Q u i r i n g d e s i g n e d a u t o - t u t o r i a l l e a r n i n g packages i n c o r p o r a t i n g e i t h e r h i g h o r low l e v e l q u e s t i o n s f o r 72 sophomore n u r s i n g s t u d e n t s i n a b a c c a l a u r e a t e program. High l e v e l q u e s t i o n s were d e f i n e d as a p p l i c a t i o n and above u s i n g Bloom's c l a s s i f i c a t i o n system. Other independent v a r i a b l e s s t u d i e d were G.P.A., c r i t i c a l t h i n k i n g measured by the Watson-Glaser C r i t i c a l T h i n k i n g A p p r a i s a l S c o r e , and immediate o r d e l a y e d feedback. The dependent v a r i a b l e s were t e s t s a d d r e s s i n g the c o g n i t i v e and psychomotor domains based on the l e a r n i n g packages. The r e s e a r c h e r found no s i g n i f i c a n t d i f f e r e n c e s f o r the e f f e c t o f h i g h and low l e v e l q u e s t i o n s on the a c h i e v e -ment s c o r e s . The e f f e c t s o f G.P.A. and c r i t i c a l t h i n k i n g were s i g n i f i c a n t on some o f the dependent measures. - 2 5 -The s t u d i e s by Hunkins (1968) and Q u i r i n g (1971) d e s c r i b e d above used w r i t t e n q u e s t i o n s i n t h e i r t r e a t m e n t s . S c h o l d r a (1973) i n v e s t i g a t e d the e f f e c t o f h i g h l e v e l o r a l q u e s t i o n s asked by n u r s i n g i n s t r u c t o r s d u r i n g c l i n i c a l and i n d i v i d u a l c o n f e r e n c e s on performance i n n u r s i n g . The dependent v a r i a b l e s were: 1) p r o p o r t i o n o f e f f e c t i v e c r i t i c a l i n c i d e n t s , 2) s c o r e s on paper and p e n c i l t e s t s , and 3) s c o r e s on two s i t u a t i o n t e s t s . S c h o l d r a t r a i n e d two i n s t r u c t o r s , b o t h w i t h b a c c a l a u r e a t e degrees, t e a c h i n g i n a c o l l e g e program i n Canada, to ask h i g h l e v e l q u e s t i o n s . They p r a c t i c e d p o s i n g q u e s t i o n s u n t i l they main-t a i n e d t h e c r i t e r i o n l e v e l s e t a t 50% h i g h l e v e l q u e s t i o n s . High l e v e l was d e f i n e d t o be comprehension and above. The c l a s s i f i c a t i o n system used was t h a t de v e l o p e d by Manson and C l e g g (1970). A t h i r d i n s t r u c t o r was g i v e n no t r a i n i n g but was r e q u e s t e d to i n c r e a s e the number o f know-ledg e q u e s t i o n s she posed. A l l c o n f e r e n c e s were a u d i o t a p e d and random checks made on the l e v e l o f q u e s t i o n s asked. The u n t r a i n e d i n s t r u c t o r asked 20% h i g h l e v e l q u e s t i o n s and the t r a i n e d i n s t r u c t o r s m a i n t a i n e d an average o f over 50% h i g h l e v e l q u e s t i o n s . Had the r e s e a r c h e r d e f i n e d h i g h l e v e l q u e s t i o n s as a n a l y s i s and above, the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by her t r a i n e d i n s t r u c t o r s was an average o f 22% and by her c o n t r o l i n s t r u c t o r , 4.5% d u r i n g c l i n i c a l c o n f e r e n c e s . A n a l y s i s of the dat a r e v e a l e d t h a t s t u d e n t s who were asked p r e d o m i n a n t l y h i g h l e v e l q u e s t i o n s s c o r e d s i g n i f i c a n t l y h i g h e r on a paper and p e n c i l t e s t than those who were asked low l e v e l q u e s t i o n s . There were no s i g n i f i c a n t d i f f e r e n c e s between the groups on the o t h e r dependent v a r -i a b l e s . -26-One i m p o r t a n t l i m i t a t i o n i n t h i s study was the f a c t t h a t the two e x p e r i m e n t a l i n s t r u c t o r s had two y e a r s and t e n y e a r s o f t e a c h i n g exper-i e n c e r e s p e c t i v e l y . The c o n t r o l i n s t r u c t o r d i d not have t e a c h i n g e x p e r -i e n c e p r i o r to the s t u d y . T h i s v a r i a n c e i n e x p e r i e n c e may have been a c o n t r i b u t i n g f a c t o r to the r e s u l t s . T h i s s e c t i o n o f the re v i e w o f the l i t e r a t u r e has p r e s e n t e d i n v e s t i g a t i o n s o f the e f f e c t o f t e a c h e r q u e s t i o n s on s t u d e n t r e s p o n s e , s t u d e n t q u e s t i o n s , and v a r i o u s measures of s t u d e n t achievement. The g e n e r a l c o n c l u s i o n s drawn from these s t u d i e s a r e : 1. High l e v e l q u e s t i o n s e l i c i t more c a r e f u l l y p h r ased and l o n g e r r e p l i e s than do low l e v e l q u e s t i o n s . 2. A d d i t i o n a l time i s r e q u i r e d by s t u d e n t s i f they a r e to a d e q u a t e l y answer a h i g h l e v e l q u e s t i o n . I n s t r u c -t o r s must be weaned away from t h e i r h a b i t o f e x p e c t i n g an i n s t a n t answer to a q u e s t i o n . 3. Where t e a c h e r s ask h i g h l e v e l q u e s t i o n s , s t u d e n t s f o l l o w s u i t . A. The e f f e c t o f h i g h l e v e l q u e s t i o n s on s t u d e n t a c h i e v e -ment i s e q u i v o c a l . The f i n a l s e c t i o n r eviews programs t h a t were d e s i g n e d t o a l t e r t e a c h e r q u e s t i o n i n g b e h a v i o r . -27-2.5 I n s t r u c t i o n i n Q u e s t i o n i n g Research i n t o t e a c h e r b e h a v i o r has been g r e a t l y i n f l u e n c e d by the work of Ned F l a n d e r s . " F l a n d e r s ' c o n t r i b u t i o n to r e s e a r c h i n cl a s s r o o m s has been i m p o r t a n t and p e r v a s i v e . Not o n l y d i d he develop the s i n g l e m o s t - o f t e n - u s e d i n s t r u m e n t f o r o b s e r v i n g c l a s s r o o m b e h a v i o r , but he has a l s o made i m p o r t a n t attempts t o u t i l i z e r e s e a r c h f i n d i n g s t o improve t e a c h i n g through t e a c h e r e d u c a t i o n . " (Dunkin and B i d d l e 1974, p.100.) The i n s t r u m e n t r e f e r r e d to i n t h i s q u o t a t i o n i s the F l a n d e r s ' I n t e r a c t i o n A n a l y s i s C a t e g o r i e s ( F . I . A . C . ) . How i t may be used and i t s a p p l i c a t i o n to t e a c h e r s e l f - d e v e l o p m e n t i s d e s c r i b e d i n A n a l y z i n g  T e a c h i n g B e h a v i o r ( F l a n d e r s 1970). Ten common b e h a v i o r s of t e a c h e r s and s t u d e n t s a r e coded 1 through 10. An o b s e r v e r w a t c h i n g a t e a c h e r - s t u d e n t i n t e r a c t i o n would t a l l y t h e s e b e h a v i o r s e v e r y t h r e e seconds. Items on the t a l l y sheet a r e t r a n s c r i b e d to a 10 x 10 m a t r i x which i s then a s s e s s e d and compared to performance c r i t e r i a . One of the ten c a t e g o r i e s c o n c e r n s t e a c h e r q u e s t i o n s . U s i n g a s i m i l a r c o d i n g system but w i t h s i x c a t e g o r i e s i s the Guided S e l f - A n a l y s i s System f o r P r o f e s s i o n a l Development E d u c a t i o n S e r i e s - Te a c h i n g f o r I n q u i r y (Parsons 1968). T h i s system i s d e s i g n e d f o r t e a c h e r s to a n a l y z e t h e i r own b e h a v i o r . Each c a t e g o r y , one o f which i s q u e s t i o n i n g , i s examined s e p a r a t e l y and the r e s u l t s a r e p l o t t e d i n t o an i n d i v i d u a l p r o -f i l e . The p r o f i l e i s then compared w i t h an " i d e a l " p r o f i l e chosen by the t e a c h e r . Should h i s p r o f i l e not match t h a t o f the i d e a l , c o g n i t i v e d i s s -onance i s aro u s e d and b e h a v i o r change e f f e c t e d . B i r c h has found t h i s - 2 8 -strategy to be e f f e c t i v e for teaching questioning s k i l l s . * A number of researchers have studied the e f f e c t s of s e l f -i n s t r u c t i o n a l modules on the questioning s k i l l s of pre-service teachers. (Lamb 1977, Welch 1976, Mervin and Schneider 1973, Z i g l e r 1972.) Each study used audiotaped discussions and pre- and post-tests and each obtained s i g n i f i c a n t increases i n the cognitive l e v e l of questions asked. In addition, Z i g l e r compared the effectiveness of two learning packages, one based on Bloom's (1956) c l a s s i f i c a t i o n system and the other on Gallagher's (1965) system. The package based on Bloom's system was found to be more e f f e c t i v e . In h i s review of research on teacher t r a i n i n g i n questioning, Lamb (1977) suggested that a module combining the elements of protocol materials, i n t e r a c t i o n analysis t r a i n i n g materials and s e l f - a n a l y s i s t r a i n i n g materials would be most e f f e c t i v e . His module, which took a mean of 6.5 hours to complete, comprised 1) a short essay explaining the impor-tance of questions, 2) a d e s c r i p t i o n of a question c l a s s i f i c a t i o n system, 3) a 120 frame programmed i n s t r u c t i o n on using the c l a s s i f i c a t i o n system, 4) an analysis of a t r a n s c r i p t , and 5) an audiotaped program i n c l u d i n g l i v e classroom behavior. This section of the review of the l i t e r a t u r e has described attempts to i n s t r u c t teachers i n questioning s k i l l s . The general con-clusions are: * Daniel Birch 1978; personal conversation. -29-1. B e h a v i o r change i s e f f e c t e d where t e a c h e r s a n a l y s e t h e i r own b e h a v i o r d u r i n g s t u d e n t - t e a c h e r i n t e r a c t i o n s and compare the r e s u l t s w i t h an " i d e a l " b e h a v i o r . 2. S e l f - i n s t r u c t i o n a l packages a r e an e f f e c t i v e mode o f i n s t r u c t i o n . 3. A c l a s s i f i c a t i o n system based on Bloom's Taxonomy was found to be s u p e r i o r . 4. Q u e s t i o n i n g s k i l l s can be l e a r n e d i n under seven h o u r s . Summary L i t e r a t u r e r e l a t e d t o the purpose o f t h i s study has been reviewed and p e r t i n e n t f i n d i n g s i d e n t i f i e d . P o s t - c l i n i c a l c o n f e r e n c e s were d e s c r i b e d i n o r d e r to demonstrate t h a t n u r s i n g s t u d e n t s need to use h i g h l e v e l s o f c o g n i t i v e thought i f they a r e to e f f e c t the n u r s i n g p r o c e s s . E x i s t i n g q u e s t i o n c l a s s i f i c a t i o n schemes and t h e i r m e r i t s and l i m i t a t i o n s were d i s c u s s e d . Experiments d e s i g n e d t o stu d y the q u e s t i o n -i n g b e h a v i o r of t e a c h e r s and the e f f e c t s o f q u e s t i o n s on s t u d e n t b e h a v i o r were then d e s c r i b e d and f i n a l l y , a s e l e c t i o n o f programs i n t e n d e d to t e a c h q u e s t i o n i n g s k i l l s was revi e w e d . The n e x t c h a p t e r g i v e s an account of the s t e p s taken i n p r e -p a r i n g the s e l f - i n s t r u c t i o n a l module and the d e c i s i o n s made based on the f i n d i n g s d e s c r i b e d i n t h i s c h a p t e r . -30-CHAPTER I I I Development o f the Module Chapter I e x p l o r e d the background of the problem i n l a c k o f q u e s t i o n i n g s k i l l s , and o f f e r e d j u s t i f i c a t i o n f o r t h i s s t u d y . Chapter I I reviewed l i t e r a t u r e r e l a t e d to s t u d i e s i n q u e s t i o n i n g . Each s e c t i o n of the review ended w i t h g e n e r a l c o n c l u s i o n s drawn from the s t u d i e s d e s c r i b e d . These c o n c l u s i o n s formed the b a s i s f o r d e c i s i o n s made r e g a r d -i n g the development of the module. A d e l i n e a t i o n o f the s t e p s taken to d e v elop the module i s p r e s e n t e d i n t h i s c h a p t e r under the headings Preview, D e f i n i t i o n o f O b j e c t i v e s , I n s t r u c t i o n a l Sequence, Content V a l i d i t y and F i e l d T e s t . 3.1 P r eview The p r e v i e w was conducted to t e s t the f e a s i b i l i t y o f r e q u e s t -i n g i n s t r u c t o r s to t a p e - r e c o r d t h e i r c l i n i c a l c o n f e r e n c e s so t h a t the l e v e l of q u e s t i o n s c o u l d be a n a l y s e d . The q u e r i e s r a i s e d were: Does the p r e s e n c e of a tape r e c o r d e r h i n d e r the c o n f e r e n c e p r o c e e d i n g s o r cause embarrassment? Can everyone be heard on the tape? Are tape r e c o r d e r s a v a i l a b l e to i n s t r u c t o r s ? Is i t l i k e l y t h a t i n s t r u c t o r s w i l l p a r t i c i p a t e i n t h i s study? -31-Three i n s t r u c t o r s , each t e a c h i n g i n a d i f f e r e n t c o l l e g e were asked to tape sample c o n f e r e n c e s . The purpose of the r e c o r d i n g s was e x p l a i n e d to t h e i r s t u d e n t s and i t was g e n e r a l l y agreed t h a t the tape r e c o r d e r was not a h i n d r a n c e . Tape r e c o r d e r s a r e now a commonly used p i e c e of equipment i n e d u c a t i o n a l s e t t i n g s and i n c l i n i c a l a r e a s . The i n s t r u c t o r s and t h e i r s t u d e n t s d e n i e d f e e l i n g s o f embarrassment on b e i n g r e c o r d e d . As tape r e c o r d e r s a r e common, they a r e r e a d i l y a v a i l a b l e f o r l o a n to i n s t r u c t o r s . G e n e r a l i n q u i r y by those t h r e e i n s t r u c t o r s produced a f a v o r a b l e r e sponse from t h e i r p e e r s r e g a r d i n g f u t u r e p a r t i c i p a t i o n i n t h i s s t u d y . The p r e v i e w s t a g e a l s o i n c l u d e d a v e r i f i c a t i o n o f performance d e f i c i t i n q u e s t i o n i n g s k i l l s . A p r e l i m i n a r y a n a l y s i s of the sample con-f e r e n c e tapes r e v e a l e d q u e s t i o n i n g l e v e l s t h a t s u p p o r t e d the f i n d i n g s o f the s t u d i e s d i s c u s s e d i n Chapter I I . The number of q u e s t i o n s asked d u r i n g f i f t e e n minute, t h i r t y minute and f o r t y - f i v e minute p e r i o d s was a s s e s s e d . F o r the purpose of t h i s study, a t h i r t y minute r e c o r d i n g o f a p o s t - c l i n i c a l c o n f e r e n c e was s e l e c t e d on the f o l l o w i n g grounds: a. T h i r t y minute t r i a l tapes y i e l d e d an average of 35 q u e s t i o n s which was c o n s i d e r e d to be a s u f f i c i e n t number f o r a n a l y s i s . b. S e l f - a n a l y s i s of a t h i r t y minute segment of c o n f e r e n c e was judged to be a r e a s o n a b l e and a c c e p t a b l e demand of an i n s t r u c t o r . -32-3.2 D e f i n i t i o n o f O b j e c t i v e s A number of f a c t o r s was c o n s i d e r e d p r i o r t o d e f i n i n g the o b j e c -t i v e s f o r the module. The major f a c t o r was the time committment asked of the i n s t r u c t o r s . A r e q u e s t f o r a heavy investment of time would i n v i t e f a i l u r e o f the f i e l d t e s t o f the module, though n o t n e c e s s a r i l y f a i l u r e o f i t s u l t i m a t e use. P r e v i o u s s e l f - i n s t r u c t i o n i n q u e s t i o n i n g had been a c c o m p l i s h e d i n a mean of 6.5 h o u r s . (Lamb 1977.) Modest o b j e c t i v e s were t h e r e f o r e g e n e r a t e d w i t h the time r e q u i r e d to meet them e s t i m a t e d to be under s i x h o u r s . Economic c o n s i d e r a t i o n s a l s o i n f l u e n c e d the scope of the o b j e c -t i v e s . The module was de v e l o p e d on a l i m i t e d budget. P r i n t i n g c o s t s p r o h i b i t e d the p r o d u c t i o n of a tome to meet o b j e c t i v e s r e g a r d i n g a l l a s p e c t s of q u e s t i o n i n g . The c h o i c e o f a c l a s s i f i c a t i o n system f o r q u e s t i o n s q u i d e d the d e f i n i t i o n of o b j e c t i v e s . A f t e r c o n s i d e r i n g the s t u d i e s d e s c r i b e d i n S e c t i o n 2.2 the q u e s t i o n c l a s s i f i c a t i o n system, shown on pages 131 and 132 of Appendix C, was d e v i s e d . T h i s scheme combines the work o f Bloom et_ a l . (1956), C l e g g e t a l . (1969), Manson and C l e g g (1970) and Hunkins (1976) w i t h m o d i f i c a t i o n s by the a u t h o r . I t was d e v i s e d w i t h two.purposes i n mind: 1. To s e r v e as a guide i n the i n s t r u c t i o n a l module. 2. To s e r v e as a guide i n c o d i n g q u e s t i o n s d u r i n g the e x p e r i m e n t a l phase. -33-The c l a s s i f i c a t i o n system has the f o l l o w i n g f e a t u r e s : 1. The f i r s t column l i s t s the major c a t e g o r i e s o f Bloom's Taxonomy (1956), namely knowledge, comprehension, a p p l i c a t i o n , a n a l y s i s , s y n t h e s i s and e v a l u a t i o n . The s e l e c t i o n o f t h i s taxonomy p r e c l u d e s the c o d i n g o f a f f e c t i v e , p r o c e d u r a l , r h e t o r i c a l and p r o b i n g q u e s t i o n s . 2. The c o g n i t i v e a c t i v i t y r e q u i r e d by the s t u d e n t to answer q u e s t i o n s a t each l e v e l comprises the second column. The major h e a d i n g s , r e c a l l , u n d e r s t a n d i n g , s o l v i n g , e x p l o r a t i o n of r e a s o n i n g , c r e a t i n g , j u d g i n g -a r e taken from Manson and C l e g g (1970) and the d e s c r i p t i o n s f o l l o w i n g each h e a d i n g are taken from C l e g g et a l . (1969) . 3. The t h i r d column l i s t s the key c o n c e p t s u n d e r l y i n g each l e v e l . These were adapted from Manson and C l e g g (1970). 4. The f o u r t h column l i s t s sample words t h a t may be used to b e g i n a q u e s t i o n d i r e c t e d to each l e v e l . The f i n d i n g s d e s c r i b e d as the "grammar o f the i n t e r r o g a t i v e " ( C l e g g e_t al_. 1969) and d i s c u s s e d i n S e c t i o n 2.3, d i c t a t e d the i n c l u s i o n o f t h i s column. The sample q u e s t i o n words are taken from C l e g g e_t a l . (1969), Hunkins (1970), w i t h a few a d d i t i o n s by the a u t h o r . T h i s c l a s s i f i c a t i o n scheme formed the b a s i s of the i n s t r u c t i o n a l module. The g e n e r a l purpose of the module was to improve the q u e s t i o n i n g s k i l l s o f c l i n i c a l n u r s i n g i n s t r u c t o r s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s by p r o v i d i n g the i n f o r m a t i o n and p r a c t i c e n e c e s s a r y f o r them to be a b l e t o : 1. C l a s s i f y q u e s t i o n s i n terms of the l e v e l s o f Bloom's Taxonomy of i n t e l l e c t u a l p r o c e s s e s . 2. Generate q u e s t i o n s a t each l e v e l o f Bloom's Taxonomy. -34-3. E v a l u a t e q u e s t i o n s asked d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s . These o b j e c t i v e s guided the i n s t r u c t i o n a l d e s i g n of the module. 3.3 I n s t r u c t i o n a l Sequence On the b a s i s o f the major o b j e c t i v e s , the module was d i v i d e d i n t o t h r e e u n i t s . I n s t r u c t i o n a l o b j e c t i v e s were then d e v e l o p e d f o r each u n i t . L e a r n i n g a c t i v i t i e s were d e s i g n e d to meet the i n s t r u c t i o n a l o b j e c -t i v e s w i t h the f o l l o w i n g l e a r n i n g p r i n c i p l e s i n mind. N a t u r a l l y , these p o i n t s do n o t c o v e r the whole spectrum of l e a r n i n g , but they were judged to be p e r t i n e n t to t h i s s t u d y . 1. " I n many c a s e s , the v o c a b u l a r y of terms used by the i n s t r u c t o r may be e n t i r e l y u n f a m i l i a r to the l e a r n e r , and t h i s may b l o c k the l e a r n i n g p r o c e s s . " ( D i c k i n s o n 1973, p.11). 2. A d u l t s a r e i n t e r e s t e d i n the immediate u s e f u l n e s s of new knowledge. L e a r n i n g i s enhanced i f c o n t e n t r e l a t e s t o problems l e a r n e r s e n c o u n t e r i n t h e i r work s e t t i n g . 3. L e a r n i n g i s an a c t i v e p r o c e s s ; a d u l t s p r e f e r to p a r t i c i -p a te i n the p r o c e s s r a t h e r than p l a y a p a s s i v e r o l e . 4. Immediate feedback r e i n f o r c e s l e a r n i n g . 5. S e l f - a n a l y s i s o f performance encourages b e h a v i o r change due to a r o u s a l of c o g n i t i v e d i s s o n a n c e (Parsons 1968). A copy of the completed module i s shown i n Appendix C. - 3 5 -The i n t r o d u c t o r y pages i n f o r m the r e a d e r of the module's purpose, c o n t e n t , a u d i o t a p i n g p r o c e d u r e , o b j e c t i v e s and o r g a n i z a t i o n . Each o f the t h r e e u n i t s b e g i n s by p r e s e n t i n g the i n s t r u c t i o n a l o b j e c t i v e s o f the u n i t , a l i s t o f r e q u i r e d m a t e r i a l s , a p r o s p e c t o f the u n i t and an e s t i m a t e o f the time r e q u i r e d to complete the u n i t . T h i s p r e l i m i n a r y i n f o r m a t i o n i s f o l l o w e d by the l e a r n i n g a c t i v i t i e s t h e m s e l v e s . Each u n i t c l o s e s w i t h a summary. U n i t I d e f i n e s a taxonomy p r i o r to d e s c r i b i n g the l e v e l s o f Bloom's Taxonomy. Each s u b - l e v e l of each c a t e g o r y o f the taxonomy i s d e s c r i b e d and two q u e s t i o n s a r e g i v e n as examples o f q u e s t i o n s t h a t may e l i c i t the type of t h i n k i n g r e q u i r e d o f each s u b - l e v e l . The s u b - l e v e l s a r e d e s c r i b e d i n o r d e r to p r e s e n t - t h e i n s t r u c t o r w i t h a s e l e c t i o n o f a l t e r n a t i v e q u e s t i o n s t h a t may be posed w i t h i n one major c a t e g o r y . F o r example, the Comprehension c a t e g o r y has t h r e e s u b - l e v e l s . Q u e s t i o n s d i r e c t e d to each o f those s u b - l e v e l s a l l comprise Comprehension q u e s t i o n s . F o l l o w i n g the d e s c r i p t i o n o f the taxonomy, f o u r s e t s o f t h i r t e e n q u e s t i o n s r e l a t e d to the c o n t e n t of a b a s i c n u r s i n g program a r e p r e s e n t e d . These may be seen on pages 122-28 o f Appendix C. The l e a r n e r must i d e n t i f y , n o t o n l y the c a t e g o r y , but the s u b - l e v e l o f each sample q u e s t i o n . Answers are p r o v i d e d i mmediately f o l l o w i n g each s e t . The q u e s t i o n c l a s s i f i c a t i o n scheme forms the summary of U n i t I. In U n i t I I , the l e a r n e r i s p r e s e n t e d w i t h s e t s o f t h r e e diagrams r e l a t e d t o n u r s i n g , t h r e e o b j e c t i v e s f o r s t u d e n t s i n a c l i n i c a l a r e a and t h r e e w r i t t e n s i m u l a t i o n s o f a s t u d e n t ' s c l i n i c a l e x p e r i e n c e . F o r each s e t , the l e a r n e r i s asked to g e n e r a t e q u e s t i o n s d i r e c t e d toward each -36-major l e v e l o f Bloom's Taxonomy; q u e s t i o n s t h a t the diagram, o b j e c t i v e o r s i m u l a t i o n s u g g e s t . Sample respo n s e s a r e p r o v i d e d immediately f o l l o w i n g each s e t . In U n i t I I I , the l e a r n e r a n a l y s e s the tape of h e r c l i n i c a l con-f e r e n c e . She i s asked to w r i t e out the q u e s t i o n s asked by b o t h h e r s e l f and her s t u d e n t s . She then a s s i g n s each q u e s t i o n to a l e v e l o f Bloom's Taxonomy. She i s r e q u e s t e d to i g n o r e p r o c e d u r a l and a f f e c t i v e q u e s t i o n s . A q u e s t i o n p r o f i l e i s then completed by c a l c u l a t i n g the r e l a t i v e p e r c e n t -age o f q u e s t i o n s asked a t each l e v e l by both the i n s t r u c t o r and the s t u d e n t s . The l e a r n e r i s d i r e c t e d to c o n s i d e r the p r o f i l e and the e f f e c t h er q u e s t i o n s might have on s t u d e n t t h i n k i n g on pages 180-83 (Appendix C) An a n n o t a t e d b i b l i o g r a p h y completes the module. An i n i t i a l d r a f t o f the module was c o m p i l e d and c o p i e s made f o r the purpose of t e s t i n g i t s c o n t e n t v a l i d i t y . 3.4 Content V a l i d i t y Two groups of people were asked to v a l i d a t e the module. The f i r s t group comprised u n i v e r s i t y p r o f e s s o r s , f o u r from the S c h o o l o f N u r s i n g and two from the F a c u l t y o f E d u c a t i o n . Four n u r s i n g i n s t r u c t o r s t e a c h i n g i n l o c a l c o l l e g e s formed the second group. -37-A l l v a l i d a t o r s were asked to rea d and complete the module. The d i r e c t i o n s shown i n F i g u r e 1 accompanied each module t o s e r v e as a guide as to the type o f feedback r e q u i r e d . The f o l l o w i n g comments and s u g g e s t i o n s were made i n r e p l y to each o f these q u e s t i o n s . 1. The c o n t e n t was c o n s i d e r e d to be t h e o r e t i c a l l y sound. Some minor changes were sug g e s t e d i n the d e s c r i p t i o n s o f the l e v e l s o f Bloom's Taxonomy i n o r d e r to a c h i e v e g r e a t e r s i m p l i c i t y . An e r r o r o f o m i s s i o n was d e t e c t e d i n the d e s c r i p t i o n o f the A n a l y s i s o f R e l a t i o n s h i p s l e v e l . 2. The i n s t r u c t i o n a l methods were judged to be sound. 3. The n u r s i n g i n s t r u c t o r s s u g g e s t e d changes i n the wording o f some q u e s t i o n s to r e f l e c t a more r e a l i s t i c approach to c l i n i c a l t e a c h i n g . For. example, one q u e s t i o n o r i g i n a l l y r e a d , "What might happen i f you gave an i n t r a m u s c u l a r i n j e c t i o n i n a p l a c e o t h e r than those I've d e s c r i b e d ? " T h i s was a l t e r e d t o r e a d , "What might happen i f you gave an i n t r a m u s c u l a r i n j e c t i o n i n the lower o u t e r quadrant o f the b u t t o c k ? " 4. O p i n i o n about the l e n g t h and ambiguity o f the l e a r n i n g a c t i v i t i e s v a r i e d . Those who were f a m i l i a r w i t h Bloom's Taxonomy thought the number o f " Q u e s t i o n s e t s " c o u l d be reduced; however, those who were u n f a m i l i a r w i t h the Taxonomy, thought t h e r e was a s u f f i c i e n t number of " Q u e s t i o n s e t s . " As the module was produced f o r a p o p u l a t i o n who were u n l i k e l y to be c o n v e r s a n t w i t h Bloom's Taxonomy, the number o f s e t s was not changed. Some a m b i g u i t i e s i n wording were d e t e c t e d and removed. 5. The language was not c o n s i d e r e d t o be e i t h e r too f o r m a l o r too i n -f o r m a l . Some o r i g i n a l a b b r e v i a t i o n s were w r i t t e n out i n f u l l a t -38-You have been g i v e n t h i s module so t h a t I may b e n e f i t from your c o n s i d e r a t i o n o f the f o l l o w i n g : 1. Content v a l i d i t y . Is the c o n t e n t t h e o r e t -i c a l l y sound? 2. I n s t r u c t i o n a l v a l i d i t y . I s the module based on sound i n s t r u c t i o n a l methods? 3. R e a l i s m . • Are the examples o f q u e s t i o n s ones t h a t a r e l i k e l y to be asked by n u r s i n g i n s t r u c t o r s t e a c h i n g i n two y e a r c o l l e g e programs? Are the s i m u l a t e d s t u d e n t e x p e r -i e n c e s r e a l i s t i c ? 4. I n t e r e s t . Are the l e a r n i n g a c t i v i t i e s i n t e r e s t i n g ? Too long? Too s h o r t ? Too c o m p l i c a t e d ? Ambiguous? 5. Language. Is the language too fo r m a l ? Too i n f o r m a l ? Too e r u d i t e ? Too f u l l o f j a r g o n ? P l e a s e f e e l f r e e to w r i t e comments as they o c c u r t o you, make a l t e r a t i o n s i n the s c r i p t , make s u g g e s t i o n s , e t c . P l e a s e query any o f my 'answers.' PLEASE make a not e o f the time (or e s t i m a t e o f ) i t took you to complete each u n i t . Record t h a t time where i t says " E s t i m a t e d time t o complete" on the o b j e c t i v e s pages o f each u n i t . F i g u r e 1. L e t t e r t o Content V a l i d a t o r s - 3 9 -th e s u g g e s t i o n of the v a l i d a t o r s . 6. Each v a l i d a t o r p r o f f e r e d an e s t i m a t e o f the time taken to complete each u n i t o f the module. On the b a s i s o f these e s t i m a t i o n s , the " E s t i m a t e d time to complete" s e c t i o n s were p r i n t e d . F o l l o w i n g the a d a p t a t i o n s d e s c r i b e d above, the module was r e -typed and p r e p a r e d f o r p r i n t i n g . A p r o f e s s i o n a l a r t i s t d e s i g n e d the c o v e r which d i s p l a y s the t i t l e , " Q u e s t i o n i n g f o r C l i n i c a l N u r s i n g I n s t r u c t o r s " f l a n k e d by l a r g e q u e s t i o n marks. A s u f f i c i e n t number o f c o p i e s was p r i n t e d to complete the f i n a l s t a g e o f the i n s t r u c t i o n a l p r o c e s s , the e v a l u a t i o n of the module. 3.5 F i e l d T e s t The f i e l d t e s t conducted to e v a l u a t e the e f f e c t i v e n e s s o f the module formed a major p a r t o f t h i s study. I t i s , t h e r e f o r e , d e s c r i b e d i n a s e p a r a t e c h a p t e r , Chapter IV. Summary T h i s c h a p t e r has d e s c r i b e d the s t e p s taken i n the development o f a s e l f - i n s t r u c t i o n a l module e n t i t l e d " Q u e s t i o n i n g f o r C l i n i c a l N u r s i n g I n s t r u c t o r s " (Appendix C ) . These s t e p s were: 1. A preview to determine the f e a s i b i l i t y o f , and p o s s i b l e -40-d i f f i c u l t i e s i n , o b t a i n i n g a u d i o t a p e s o f p o s t - c l i n i c a l c o n f e r e n c e s . 2. The d e s i g n o f a c l a s s i f i c a t i o n system as the t h e o r y base of the module. 3. The d e f i n i t i o n o f the major and the i n s t r u c t i o n a l o b j e c -t i v e s o f the module. 4. The d e s i g n o f the i n s t r u c t i o n a l sequence and the d e v e l o p -ment of l e a r n i n g a c t i v i t i e s to meet the o b j e c t i v e s . 5. The r e q u e s t f o r ' e x p e r t ' o p i n i o n as a b a s i s f o r d e t e r m i n i n g the c o n t e n t v a l i d i t y o f the module. 6. R e v i s i o n s o f the module f o l l o w i n g s u g g e s t i o n s o b t a i n e d i n Step 5. The f i n a l s t e p , the f i e l d t e s t t o e v a l u a t e the e f f e c t i v e n e s s o f t h e module, i s d e s c r i b e d i n Chapter IV. -41-CHAPTER IV  F i e l d T e s t T h i s c h a p t e r d e s c r i b e s the f i e l d t e s t t o e v a l u a t e the e f f e c t i v e n e s s o f the s e l f - i n s t r u c t i o n a l module. T o p i c s a r e c o n s i d e r e d under the h e a dings S u b j e c t s , D e s i g n of the Study, P r o c e d u r e and Data C o l l e c t i o n . 4.1 S u b j e c t s The p o p u l a t i o n f o r t h i s study was d e f i n e d as " n u r s i n g i n s t r u c -t o r s who t e a c h i n two-year c o l l e g e programs, whose p r i m a r y r e s p o n s i b i l i t y i s the s u p e r v i s i o n of s t u d e n t s w i t h i n c l i n i c a l a r e a s and who wish to improve t h e i r q u e s t i o n i n g s k i l l s . " S u b j e c t s were those n u r s i n g i n s t r u c -t o r s , from the above p o p u l a t i o n , who were w i l l i n g to v o l u n t e e r the time r e q u i r e d to work through the module. Four c o l l e g e s i n B r i t i s h Columbia were approached i n o r d e r to seek v o l u n t e e r s who would be w i l l i n g to t e s t the module. These c o l l e g e s were the B r i t i s h Columbia I n s t i t u t e o f Technology, Vancouver C i t y C o l l e g e , Douglas C o l l e g e and C a r i b o o C o l l e g e . The B r i t i s h Columbia I n s t i t u t e o f Technology o f f e r s two programs i n n u r s i n g , one l e a d i n g to g e n e r a l n u r s e r e g i s t r a t i o n , and one l e a d i n g to p s y c h i a t r i c n u r s e r e g i s t r a t i o n . A l t h o u g h housed on the same campus, the two programs have a s e p a r a t e f a c u l t y and -42-c u r r i c u l u m . T h e r e f o r e , these programs were c o n s i d e r e d to be two i n s t i t u t i o n s f o r the purpose of t h i s study. In a d d i t i o n , the second y e a r team o f the b a c c a l a u r e a t e program a t the U n i v e r s i t y o f B r i t i s h Columbia was asked to p a r t i c i p a t e , as the co n t e n t o f the second y e a r program i s s i m i l a r to t h a t o f a c o l l e g e . Thus, a t o t a l o f s i x n u r s i n g f a c u l t i e s was approached. I n i t i a l c o n t a c t w i t h the s c h o o l s was made by t e l e p h o n e c o n v e r s a t i o n w i t h the D i r e c t o r s . F o l l o w i n g the e x p l a n a t o r y c o n v e r s a -t i o n , a l e t t e r was sen t to the D i r e c t o r r e q u e s t i n g time d u r i n g a f a c u l t y meeting f o r the e x p e r i m e n t e r t o e x p l a i n the stu d y t o f a c u l t y and to c a l l f o r v o l u n t e e r s . The f i v e s c h o o l s i n the Vancouver r e g i o n were v i s i t e d . The r e m a i n i n g s c h o o l was not i n the"Vancouver a r e a and a l l c o n t a c t was by tel e p h o n e o r l e t t e r . At the f a c u l t y meetings, the e x p l a n a t o r y l e t t e r , i n s t r u c t i o n s f o r t a p i n g , and a 'consent' form, shown i n Appendix A, were d i s t r i b u t e d . The e x p e r i m e n t e r b r i e f l y d i s p l a y e d the module, d e s c r i b e d i t s purpose and s t a t e d t h a t the aim o f the f i e l d t e s t was to e v a l u a t e the e f f e c t i v e -ness o f the module, not the t e a c h i n g p r a c t i c e s o f the i n s t r u c t o r s . A r e q u e s t was made f o r v o l u n t e e r s who would be w i l l i n g to s u p p l y the ex p e r i m e n t e r w i t h two r e c o r d i n g s o f p o s t - c l i n i c a l c o n f e r e n c e s and who were p r e p a r e d t o spend the time r e q u i r e d t o study the module. As s u r a n c e was g i v e n t h a t the tapes would be hea r d by the e x p e r i m e n t e r o n l y . - 4 3 -V o l u n t e e r s were asked to complete the 'consent' form. The i n s t r u c t i o n s f o r t a p i n g were e x p l a i n e d and a b l a n k a u d i o t a p e p r o v i d e d f o r the r e c o r d i n g o f the f i r s t c o n f e r e n c e . Due to the v a r i a t i o n i n c l i n i c a l assignment hours, s c h e d u l e s and r o t a t i o n s , i t was i m p o s s i b l e to s p e c i f y dates f o r the r e c o r d i n g s . Nor was i t p o s s i b l e to p r e s c r i b e a s p e c i f i c time i n t e r v a l between the two c o n f e r e n c e s r e c o r d e d . 4.2 D e s i g n o f the Study The e x p e r i m e n t a l d e s i g n f o r t h i s study was a p r e t e s t - p o s t t e s t c o n t r o l group d e s i g n , (Campbell and S t a n l e y 1963, p.13). E x p e r i m e n t a l Group RO-^  X C>2 C o n t r o l Group R O 3 X 0 ^ The dependent v a r i a b l e was the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s d u r i n g a t h i r t y minute segment o f a p o s t - c l i n i c a l c o n f e r e n c e . The independent v a r i a b l e was the s e l f - i n s t r u c t i o n a l module on q u e s t i o n i n g . The f i r s t n u l l h y p o t h e s i s was t h a t t h e r e w i l l be no s i g n i f i c a n t i n c r e a s e i n the p e r c e n t a g e of h i g h l e v e l q u e s t i o n s asked d u r i n g p o s t -c l i n i c a l c o n f e r e n c e s by i n s t r u c t o r s who used the module r e l a t i v e to i n s t r u c t o r s who d i d n o t . A second e x p e r i m e n t a l i s s u e p e r t a i n e d to the r e l a t i o n s h i p be-tween the l e v e l o f q u e s t i o n s asked by f a c u l t y and those asked by s t u d e n t s . -44-R e l a t i v e to t h i s r e l a t i o n s h i p the n u l l h y p o t h e s i s was t h a t t h e r e w i l l be no s i g n i f i c a n t c o r r e l a t i o n between the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s and the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by t h e i r s t u d e n t s d u r i n g these c o n f e r e n c e s . The f o l l o w i n g p o i n t s were c o n s i d e r e d d u r i n g the d e s i g n o f t h i s s t u d y : 1. A l t h o u g h s u b j e c t s were v o l u n t e e r s , they n e v e r t h e l e s s r e p r e s e n t e d a sample o f the p o p u l a t i o n f o r whom the module was i n t e n d e d , i . e . , i n s t r u c t o r s who ex p r e s s an i n t e r e s t i n i m p r o v i n g t h e i r q u e s t i o n i n g s k i l l s . 2. The random d i v i s i o n o f s u b j e c t s w i t h i n each c o l l e g e s h o u l d c o n t r o l f o r i n s t i t u t i o n a l e f f e c t s . 3. Treatment c o n t a m i n a t i o n was a p o s s i b i l i t y as i t was c o n c e i v a b l e t h a t i n s t r u c t o r s who shar e d an o f f i c e c o u l d be a s s i g n e d t o d i f f e r e n t groups. Requests f o r c o n f i d e n t i a l i t y were made. E r r o r s r e s u l t i n g from such c o n t a m i n a t i o n would tend to reduce the apparent e f f e c t o f the module. 4. The e f f e c t o f ' t e s t i n g ' (Campbell and S t a n l e y 1963) was n e g l i g i b l e as s u b j e c t s i n the c o n t r o l group were asked t o a u d i o t a p e a c o n f e r e n c e and a f t e r a p e r i o d o f time, a u d i o t a p e a second c o n f e r e n c e . D u r i n g the i n t e r v e n i n g time they were g i v e n no feedback on the f i r s t a u d i o t a p e . 5. The a s k i n g o f more q u e s t i o n s than u s u a l by s u b j e c t s because of t h e i r p a r t i c i p a t i o n i n the study was not a t h r e a t t o i n t e r n a l v a l i d i t y , as i t was the l e v e l o f q u e s t i o n s t h a t was measured, not the number. - 4 5 -4.3 P r o c e d u r e The f i r s t c o n t a c t w i t h s u b j e c t s was a t the f a c u l t y meetings where v o l u n t e e r s f o r the study were e n l i s t e d . Communication w i t h sub-j e c t s a f t e r the f a c u l t y meetings was on an i n d i v i d u a l b a s i s . H a n d w r i t t e n n o t e s or t e l e p h o n e c a l l s were used i n an e f f o r t t o m a i n t a i n i n i t i a l e nthusiasm. The s u c c e s s o f the f i e l d t e s t r e s t e d on the m o t i v a t i o n o f the s u b j e c t s to i n v e s t the time r e q u i r e d to complete the module. A l l s u b j e c t s were asked t o r e c o r d a t h i r t y minute segment o f a p o s t - c l i n i c a l c o n f e r e n c e . The i n s t r u c t i o n s f o r r e c o r d i n g these con-f e r e n c e s were w r i t t e n o u t . A sample o f the d i r e c t i o n s h e e t i s shown i n Appendix A. As the p r e t e s t tapes were r e c e i v e d , s u b j e c t s were a s s i g n e d t o e i t h e r the e x p e r i m e n t a l group, (Group E ) , o r the c o n t r o l group, (Group C). The f i r s t s u b j e c t w i t h i n one c o l l e g e to p r o v i d e a tape was a s s i g n e d to Group E, the second s u b j e c t w i t h i n the same c o l l e g e , t o Group C, and so on. T h i s method o f random assignment was chosen because the a t t r i t i o n r a t e was e x p e c t e d to be h i g h . Had s u b j e c t s been a s s i g n e d to a group p r i o r to the r e c e i p t o f a tape, i t i s c o n c e i v a b l e t h a t a l l 'drop-outs' c o u l d have been from the same group. A f t e r the p r e t e s t tape was made, Group E r e c e i v e d the module p l u s a copy o f the p r e t e s t tape. S u b j e c t s were r e q u e s t e d t o r e t u r n the module to the e x p e r i m e n t e r as soon as i t was completed. On r e c e i p t o f - 4 6 -the completed module, a b l a n k a u d i o t a p e was g i v e n to the s u b j e c t so t h a t a second p o s t - c l i n i c a l c o n f e r e n c e c o u l d be r e c o r d e d . The e x e r c i s e s i n the modules were checked to ensure t h a t the members o f the e x p e r i m e n t a l group had, i n f a c t , worked through the b o o k l e t . When the p o s t t e s t tape was r e c e i v e d , the module was r e t u r n e d to the s u b j e c t w i t h a l e t t e r thank-i n g h e r f o r h e r p a r t i c i p a t i o n . S u b j e c t s i n Group C, a f t e r r e c o r d i n g the p r e t e s t t ape, were t o l d t h a t they would not r e c e i v e a module at t h a t ' t i m e . They were g i v e n a b l a n k a u d i o t a p e and asked to r e c o r d a second p o s t - c l i n i c a l c o n f e r e n c e a p p r o x i m a t e l y s i x weeks a f t e r the f i r s t . F o l l o w i n g r e c e i p t of the p o s t -t e s t t ape, a module p l u s a copy of the p o s t t e s t tape was g i v e n to each s u b j e c t . A l e t t e r o f thanks accompanied the module. 4.4 Data C o l l e c t i o n Each tape of a p o s t - c l i n i c a l c o n f e r e n c e was l i s t e n e d to by the e x p e r i m e n t e r . A l l q u e s t i o n s asked by b o t h i n s t r u c t o r and s t u d e n t s were t r a n s c r i b e d onto paper. S e l e c t e d examples o f t r a n s c r i b e d q u e s t i o n s s h e e t s are shown i n Appendix B. These s h e e t s were s e l e c t e d as r e p r e s e n -t a t i v e o f p r e - and p o s t - t a p e s , and o f the v a r i e t y and s t y l e o f the q u e s t i o n s asked. P r i o r to the e x p e r i m e n t e r a s s i g n i n g q u e s t i o n s to a l e v e l o f Bloom's Taxonomy, i n t e r r a t e r r e l i a b i l i t y was e s t a b l i s h e d . Two p e r s o n s - 4 7 -who had t e s t e d the module i n i t s d e v e l o p m e n t a l s t a g e and who were, t h e r e -f o r e , f a m i l i a r w i t h the c l a s s i f i c a t i o n system, met w i t h the e x p e r i m e n t e r . These i n d i v i d u a l s were rea d the " D i r e c t i o n s to R a t e r s " shown i n F i g u r e 2. D i r e c t i o n s t o R a t e r s 1. B r i e f l y r e v i e w the d e s c r i p t i o n s of Bloom's Taxonomy i n the module. 2. Study the q u e s t i o n c l a s s i f i c a t i o n c h a r t . 3. A s s i g n each q u e s t i o n on the q u e s t i o n s h e e t to a l e v e l . W r i t e b e s i d e each K, C, Ap, An, s , o r E . 4. Q u e s t i o n s t h a t a r e d i f f i c u l t to code. a) P r o c e d u r a l q u e s t i o n s such a s , "Do you have a copy?" "Who would l i k e to speak f i r s t ? " - mark P. I n c l u d e i n t h i s c a t e g o r y q u e s t i o n s t h a t draw s t u d e n t s i n t o the d i s c u s s i o n . b) R h e t o r i c a l q u e s t i o n s such as, "She was anxious about the t r e a t m e n t s wasn't she?" - mark Rh. c) Q u e s t i o n s d i r e c t e d toward the a f f e c t i v e domain such as, "How d i d knowing h e r p e r s o n a l l y a f f e c t your c a r e ? " - mark Af . F i g u r e 2. D i r e c t i o n s to R a t e r s -48-F o l l o w i n g a b r i e f t r a i n i n g s e s s i o n , f i f t y q u e s t i o n s from the t r a n s c r i b e d s h e e t s were s e l e c t e d a t random and i n d e p e n d e n t l y coded by each r a t e r . The p e r c e n t a g e of agreement between each p a i r o f r a t e r s and the average p e r c e n t agreement, were c a l c u l a t e d . The average p e r c e n t agreement was 86.7%. R e s u l t s a r e shown i n T a b l e I. Having e s t a b l i s h e d a s a t i s f a c t o r y i n t e r r a t e r r e l i a b i l i t y c o e f f i c i e n t , the r e m a i n i n g q u e s t i o n s h e e t s were coded by the e x p e r i m e n t e r a l o n e . A t o t a l o f 659 q u e s t i o n s was a n a l y s e d . T a b l e I. I n t e r r a t e r R e l i a b i l i t y T o t a l q u e s t i o n s a n a l y s e d = 50 R e l i a b i l i t y between // d i f f e r e n c e s % agreement* A and B 8 84 A and C 3 94 B and C 9 82 Average % agreement = 86 .7 * C a l c u l a t e d by t h i s f o r m u l a : % agreement = 100 - # d i - 4 9 -Summary T h i s c h a p t e r has d e s c r i b e d the f i e l d t e s t t h a t was conducted to e v a l u a t e the e f f e c t i v e n e s s o f a s e l f - i n s t r u c t i o n a l module on q u e s t i o n -i n g s k i l l s f o r n u r s i n g i n s t r u c t o r s . F i v e n u r s i n g f a c u l t i e s from c o l l e g e s and one from a u n i v e r s i t y w i t h i n B r i t i s h Columbia were approached i n o r d e r t o seek v o l u n t e e r i n s t r u c t o r s f o r the study. Data were c o l l e c t e d on taped r e c o r d i n g s o f p o s t - c l i n i c a l c o n f e r e n c e s . The d e s i g n f o r the st u d y was a p r e t e s t -p o s t t e s t c o n t r o l group d e s i g n . Q u e s t i o n s asked by b o t h i n s t r u c t o r and s t u d e n t s d u r i n g the p o s t - c l i n i c a l c o n f e r e n c e s were t r a n s c r i b e d onto paper. F o l l o w i n g a t r a i n i n g s e s s i o n , f i f t y randomly s e l e c t e d q u e s t i o n s were coded i n d e p e n -d e n t l y by t h r e e r a t e r s . The average p e r c e n t agreement between the t h r e e r a t e r s was 86.7%. The r e m a i n i n g q u e s t i o n s were coded by the ex p e r i m e n t e r a l o n e . A t o t a l o f 659 q u e s t i o n s was a n a l y s e d . The n e x t c h a p t e r d e s c r i b e s the r e s u l t s o f the f i e l d t e s t and the c o n c l u s i o n s drawn from the r e s u l t s . -50-CHAPTER V  R e s u l t s The r e s u l t s o f the a n a l y s i s o f the dat a a r e d i s c u s s e d i n t h i s c h a p t e r under the headings Data, A n a l y s i s , and D i s c u s s i o n o f the F i n d i n g s . 5.1 Data C o n s i d e r a b l e d i f f i c u l t y was encountered i n o b t a i n i n g and k e e p i n g v o l u n t e e r s f o r t h i s s t u d y . I n i t i a l l y 26 i n s t r u c t o r s from s i x s c h o o l s v o l u n t e e r e d . One i n s t r u c t o r from one c o l l e g e v o l u n t e e r e d and d i d n ot produce a p r e t e s t t a p e . Four i n s t r u c t o r s from the u n i v e r s i t y s c h o o l v o l u n t e e r e d and o f t h o s e , one produced a p r e t e s t tape but n o t a p o s t t e s t tape. Of the r e m a i n i n g 24 i n s t r u c t o r s , s i x d i d not produce a p r e t e s t tape and f o u r d i d not produce a p o s t t e s t tape. The f i n a l number of i n s t r u c t o r s was 14, r e p r e s e n t i n g f o u r f a c u l t i e s o f n u r s i n g . Of the 14 s u b j e c t s , s i x were i n the e x p e r i m e n t a l group and e i g h t i n the c o n t r o l group. D u r i n g 28 t h i r t y minute tapes of p o s t - c l i n i c a l c o n f e r e n c e s , the t o t a l number o f q u e s t i o n s asked by i n s t r u c t o r s was 513. Of t h e s e , 56 were p r o c e d u r a l , r h e t o r i c a l or a f f e c t i v e q u e s t i o n s . The r e m a i n i n g 457 q u e s t i o n s r e l a t e d to c o g n i t i v e i s s u e s and were used f o r the a n a l y s i s . -51-The t o t a l number of q u e s t i o n s asked by s t u d e n t s was 146. Of t h e s e , 32 were p r o c e d u r a l , r h e t o r i c a l o r a f f e c t i v e q u e s t i o n s . The r e -ma i n i n g 114 q u e s t i o n s r e l a t e d to c o g n i t i v e i s s u e s and were used f o r the a n a l y s i s . 5.2 A n a l y s i s The a n a l y s i s o f the q u e s t i o n s c o n s i s t e d f i r s t o f a s s i g n i n g each q u e s t i o n to a l e v e l o f Bloom's Taxonomy. High l e v e l q u e s t i o n s were c o n s i d e r e d to be those a s s i g n e d t o the a p p l i c a t i o n l e v e l o r above. The second s t e p i n the a n a l y s i s o f the q u e s t i o n s was t o c a l c u l a t e the number and the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s f o r each i n s t r u c t o r and s t u d e n t group. R e s u l t s a r e d i s p l a y e d i n T a b l e I I . The f i e l d t e s t to e v a l u a t e the e f f e c t i v e n e s s o f the s e l f -i n s t r u c t i o n a l module was conducted to a s c e r t a i n whether the module s i g n i f i c a n t l y i n c r e a s e d the l e v e l o f q u e s t i o n s asked by i n s t r u c t o r s who s t u d i e d i t , r e l a t i v e to those who had n o t . A secondary c o n s i d e r a t i o n was whether t h e r e was a c o r r e l a t i o n between the l e v e l o f q u e s t i o n s asked by s t u d e n t s and the l e v e l o f q u e s t i o n s asked by t h e i r i n s t r u c t o r . F i n d i n g s i n R e l a t i o n to H y p o t h e s i s One The f i r s t h y p o t h e s i s t e s t e d was t h a t , There w i l l be no s i g n i f i c a n t i n c r e a s e i n the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s by i n s t r u c t o r s who have used a s e l f - i n s t r u c t i o n a l module r e -l a t i v e to i n s t r u c t o r s who have n o t . - 5 2 -T a b l e I I . T o t a l Number of Q u e s t i o n s and P e r c e n t o f High L e v e l Q u e s t i o n s asked by I n s t r u c t o r s and t h e i r Students X I.Lml Quntlona •A O -A © o © © o © o o *n IN o O *n O CM © • • •V s ft. rt • r § ~i -I o *>4 e o © o e O O *H O »•« O e • I n O O -9 •» «• "5 «-> cn » e :I ° ° s g jj © o rt o o o e e o © • V M ft. : i Si • - i a — S " H l O O IN «•» rt © O o o o o © © © CM ~4 m v c > 0 Si • m X V «0 O «n <*P aA aH n o O < ^ o d © •o m rt •n cn o CM »n o CM •rt » «* r- »n a^ CM <e •-4 cn • • •V 0 a. 1 i B -1 S rt 0 " ° 2 - CM ictor £ • • O « CM CM •O rv « O CM <* *n o r - * cr C • 0 M • • hi Si ii t § • - g « » r* O 5 * 8 * f*. « «-« O « >H « a-4 *H W C*t f-» • > • * « • * aH aH •* •H r-*»* O « e o CM -3 i i u . p u • « » p rt m o o e a» w u 8 © S 2 U U M U N i n <o O »H »H n M u «* CM cn M CM CM M U O cn *-« M i i J 1 1 Eu5 M « u a-4 5 rt CM cn -* - 5 3 -The d i f f e r e n c e i n p r e t e s t and p o s t t e s t p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s f o r the e x p e r i m e n t a l group and the c o n t r o l group was c a l c u l a t e d and the r e s u l t s a r e shown i n T a b l e I I I . The d i f f e r e n c e i n these p e r c e n t a g e s between the two groups was compared u s i n g a t t e s t as shown i n T a b l e IV. A " t " v a l u e of 2.01 was found, which, w i t h 12 degrees o f freedom i n a t w o - t a i l e d t e s t i s s i g n i f i c a n t a t the 0.05 l e v e l . H y p o t h e s i s one was r e j e c t e d . F i n d i n g s i n R e l a t i o n to H y p o t h e s i s Two The second h y p o t h e s i s was t h a t , There w i l l be no s i g n i f i c a n t c o r r e l a t i o n between the p e r -centage o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s and the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by t h e i r s t u d e n t s d u r i n g these c o n f e r e n c e s . The number of q u e s t i o n s , s u i t a b l e f o r a n a l y s i s , asked by s t u d e n t s was 114 o v e r 28 c o n f e r e n c e s , g i v i n g an average of f o u r q u e s t i o n s per con-f e r e n c e . In many c a s e s , the q u e s t i o n s asked by s t u d e n t s , c o u l d not be heard on the tape. Due to the l a c k of s u f f i c i e n t d a t a , h y p o t h e s i s two was abandoned. 5.3 D i s c u s s i o n of the F i n d i n g s The f i r s t n u l l h y p o t h e s i s was r e j e c t e d a t the 0.05 l e v e l o f s i g n i f i c a n c e . The r e s u l t s i n d i c a t e d t h a t i n s t r u c t o r s who used the s e l f -i n s t r u c t i o n a l module asked a h i g h e r p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s than those i n s t r u c t o r s who d i d n o t . I t was c o n c l u d e d t h a t the s e l f -i n s t r u c t i o n a l module was an e f f e c t i v e method o f t e a c h i n g n u r s i n g i n s t r u c -t o r s how to improve one a s p e c t of t h e i r q u e s t i o n i n g s k i l l s . -54-T a b l e I I I . P r e t e s t and P o s t t e s t S c o r e s o f the E x p e r i m e n t a l and the C o n t r o l Group Group E S u b j e c t P r e t e s t % P o s t t e s t % D i f f e r e n c e % * 01 40.9 53.6 12.7 02 8.1 62.5 54.4 09 16.7 50.0 33.3 13 20.0 31.6 11.6 14 7.1 7.5 0.4 15 14.3 5.3 -9.0 n = 6 x = 17.23% S 2= 532.66 * The symbol X denotes the dependent v a r i a b l e " p e r c e n t d i f f e r e n c e " i n the r i g h t hand column of these t a b l e s . Group C S u b j e c t P r e t e s t % P o s t t e s t % D i f f e r e n c e % * 03 6.7 5.0 -1.7 06 81.8 83.3 1.5 07 0 0 0 10 30.0 16.7 -13.3 16 13.3 20.0 6.9 18 11.8 10.0 -1.8 22 0 5.9 5.9 23 16.7 21.4 4.7 n = 8 x = 0.28% S 2= 289.78 - 5 5 -T a b l e IV. Formulae used to C a l c u l a t e the V a r i a n c e and the t T e s t ' E x 2 - ( E x ) 2 / n t = X l - x 2 n-1 / ( n - l ) S 2 ! + ( n 2 - l ) S 2 2 £ X l 2 = 4445.26 + n 2 - 2 = 10691.56 x i = 17.23 E x 2 2 289.78 x 2 = 0.28 ( X x 2 ) 2 4.84 tlx = n 2 = t = •95fc12 6 8 2.01 = 1.78 The second n u l l h y p o t h e s i s was abandoned due to i n s u f f i c i e n t d a t a f o r a n a l y s i s . The second h y p o t h e s i s was f o r m u l a t e d to add f u r t h e r s u p p o r t to the f i n d i n g s o f D a v i s and T i n s l e y (1967), and Johns (1968), which showed a s i g n i f i c a n t c o r r e l a t i o n between the i n c i d e n c e o f t h o u g h t -p r o v o k i n g q u e s t i o n s asked by s t u d e n t s and the i n c i d e n c e o f t h o u g h t -p r o v o k i n g q u e s t i o n s asked by t e a c h e r s . The f a i l u r e o f t h i s study to be a b l e to t e s t the second h y p o t h e s i s was u n f o r t u n a t e , s i n c e no i n f e r e n c e s can now be made about the i n d i r e c t e f f e c t s of the module i n i n f l u e n c i n g the l e v e l o f q u e s t i o n s asked by those s t u d e n t s whose i n s t r u c t o r had completed the module. - 5 6 -L i m i t a t i o n s o f the Study Recognized l i m i t a t i o n s o f the study were: 1. The use of p e r c e n t a g e as a s c o r e had l i m i t a t i o n s i n cases where a s m a l l t o t a l number of q u e s t i o n s was asked. A d i f f e r e n c e of one o r two h i g h or low l e v e l q u e s t i o n s i n a s m a l l sample of q u e s t i o n s , e.g., s i x , would make a c o n s i d e r a b l e d i f f e r e n c e i n the p e r c e n t a g e s c o r e d e s c r i b i n g the p r o p o r t i o n o f h i g h l e v e l q u e s t i o n s asked. 2. The use o f a c l a s s i f i c a t i o n system based on Bloom's Taxonomy r e v e a l e d t h e l i m i t a t i o n s i d e n t i f i e d by G a l l (1970) and d i s c u s s e d i n S e c t i o n 2.2. F o r example, q u e s t i o n s to cue s t u d e n t s to improve a response were d i f f i c u l t to code. Where the i n i t i a l q u e s t i o n was c l a s s i f i e d as an a n a l y s i s q u e s t i o n and the f o l l o w i n g p r o b i n g q u e s t i o n s u g g e s t e d the answer, the r a t e r found d i f f i c u l t y i n d e c i d i n g i f the p r o b i n g q u e s t i o n s h o u l d be coded as a n a l y s i s l i k e the f i r s t , o r coded at a lower l e v e l . An a d d i t i o n a l problem r e l a t e d t o q u e s t i o n s d i r e c t e d to the a f f e c t i v e domain. These were r e a d i l y coded as such, but were not i n c l u d e d i n the a n a l y s i s . The s u b j e c t s i n t h i s study were r e q u e s t e d to conduct t h e i r c o n f e r e n c e s i n the u s u a l f a s h i o n . In these c o n f e r e n c e s , n u r s i n g i n s t r u c t o r s f r e q u e n t l y address the a f f e c t i v e domain o f s t u d e n t s who f i n d themselves i n u n u s u a l , and o f t e n e m o t i o n a l l y charged, s i t u a t i o n s . A f f e c t i v e q u e s t i o n s a r e not w i t h o u t v a l u e , but w i t h i n t h i s s t u d y , they became a h i n d r a n c e when they reduced the number o f q u e s t i o n s a v a i l a b l e f o r a n a l y s i s . For example, one c o n f e r e n c e , not used i n the a n a l y s i s , y i e l d e d f o u r t e e n i n s t r u c t o r q u e s t i o n s , o f which seven were a f f e c t i v e . 3. Four n u r s i n g f a c u l t i e s were r e p r e s e n t e d , w i t h a t l e a s t one s u b j e c t i n both the c o n t r o l and the e x p e r i m e n t a l group. However, due to the -57-s m a l l sample s i z e , i t was i m p o s s i b l e to s t u d y p o s s i b l e i n s t i t u t i o n a l e f f e c t s . Summary The number of s u b j e c t s i n t h i s s t u d y was 14 r e p r e s e n t i n g f o u r n u r s i n g f a c u l t i e s . Of these s u b j e c t s , s i x were i n the e x p e r i m e n t a l group and e i g h t i n the c o n t r o l group. From 28 t h i r t y minute c o n f e r e n c e s , 457 i n s t r u c t o r q u e s t i o n s and 114 s t u d e n t q u e s t i o n s were a n a l y s e d . T h i s c h a p t e r has d e s c r i b e d the r e s u l t s o f the a n a l y s i s o f these q u e s t i o n s which showed t h a t t h e r e was a s i g n i f i c a n t i n c r e a s e i n the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s by i n s t r u c t o r s who had used a s e l f - i n s t r u c t i o n a l module r e l a t i v e t o i n s t r u c t o r s who had n o t . Due to i n s u f f i c i e n t d a t a i t was not p o s s i b l e t o t e s t the second e x p e r i -m ental h y p o t h e s i s o f t h i s study p e r t a i n i n g to the r e l a t i o n s h i p between the p e r c e n t a g e of h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s d u r i n g p o s t -c l i n i c a l c o n f e r e n c e s and the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by t h e i r s t u d e n t s . Chapter VI summarizes t h i s s t u d y , d i s c u s s e s the c o n c l u s i o n s drawn from the r e s u l t s and s u g g e s t s i d e a s f o r f u r t h e r s t u d y . -58-CHAPTER VI Summary, C o n c l u s i o n s and Recommendations  6.1 Summary The p r i m a r y purpose o f t h i s study was to d e v e l o p a s e l f -i n s t r u c t i o n a l module f o r n u r s i n g i n s t r u c t o r s to h e l p them improve t h e i r q u e s t i o n i n g s k i l l s . A 112 page manual was d e s i g n e d t o meet the f o l l o w -i n g o b j e c t i v e s . On c o m p l e t i o n of the module the l e a r n e r w i l l be a b l e t o : 1. c l a s s i f y q u e s t i o n s i n terms of the l e v e l s o f Bloom's Taxonomy o f i n t e l l e c t u a l p r o c e s s e s . 2. ge n e r a t e q u e s t i o n s a t each l e v e l o f Bloom's Taxonomy. 3. e v a l u a t e q u e s t i o n s asked d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s . A q u e s t i o n c l a s s i f i c a t i o n scheme based on Bloom's Taxonomy, which combined and adapted the work o f t h r e e p r e v i o u s r e s e a r c h e r s , s e r v e d as the t h e o r e t i c a l base f o r the module and f o r the c o d i n g o f q u e s t i o n s i n the e x p e r i m e n t a l phase. L e a r n i n g a c t i v i t i e s i n c l u d e d r e a d i n g , i d e n t i f i c a t i o n o f q u e s t i o n s , g e n e r a t i o n o f q u e s t i o n s and a n a l y s i s o f the q u e s t i o n s asked d u r i n g a r e c o r d -i n g o f one o f the l e a r n e r ' s p o s t - c l i n i c a l c o n f e r e n c e s . -59-A study was conducted t o t e s t the e f f e c t i v e n e s s o f the module. The d e s i g n o f the s t u d y was a p r e t e s t - p o s t t e s t c o n t r o l group d e s i g n . F o u r t e e n v o l u n t e e r n u r s i n g i n s t r u c t o r s r e p r e s e n t i n g f o u r n u r s i n g f a c u l t i e s c o n s t i t u t e d the sample. Of t h e s e , s i x formed the e x p e r i m e n t a l group and e i g h t the c o n t r o l group. Two n u l l hypotheses were t e s t e d . 1. There w i l l be no s i g n i f i c a n t i n c r e a s e i n the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s by i n s t r u c t o r s who have used a s e l f - i n s t r u c t i o n a l module r e l a t i v e to i n s t r u c t o r s who have n o t . 2. There w i l l be no s i g n i f i c a n t c o r r e l a t i o n between the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s and the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by t h e i r s t u d e n t s d u r i n g these c o n f e r e n c e s . From 28 t h i r t y minute taped c o n f e r e n c e s , 457 i n s t r u c t o r q u e s t i o n s and 114 s t u d e n t q u e s t i o n s were a s s i g n e d to a l e v e l o f Bloom's Taxonomy. High l e v e l q u e s t i o n s were c o n s i d e r e d to be a t t h e a p p l i c a t i o n l e v e l o r above. The p e r c e n t a g e of h i g h l e v e l q u e s t i o n s asked by the i n s t r u c t o r and by the s t u d e n t group was c a l c u l a t e d f o r each c o n f e r e n c e . G a i n s c o r e s f o r the i n s t r u c t o r s were c a l c u l a t e d . The d i f f e r e n c e i n g a i n s c o r e s between the e x p e r i m e n t a l and c o n t r o l group was compared u s i n g a t t e s t . The t t e s t i n d i c a t e d a v a l u e o f 2.01 which i s s i g n i f i c a n t a t the 0.05 l e v e l . The f i r s t h y p o t h e s i s was r e j e c t e d . -60-Th e second h y p o t h e s i s was abandoned due t o i n s u f f i c i e n t d a t a . One hundred and f o u r t e e n s t u d e n t q u e s t i o n s o v e r 28 c o n f e r e n c e s y i e l d e d an average of f o u r q u e s t i o n s per c o n f e r e n c e which was n o t c o n s i d e r e d a s u f f i c i e n t number f o r a n a l y s i s . Of the 28 c o n f e r e n c e s , 19 e l i c i t e d under f i v e s t u d e n t q u e s t i o n s . 6.2 C o n c l u s i o n s T h i s study found t h a t a s e l f - i n s t r u c t i o n a l module e n t i t l e d " Q u e s t i o n i n g f o r C l i n i c a l N u r s i n g I n s t r u c t o r s " was e f f e c t i v e i n r a i s i n g the p e r c e n t a g e of h i g h l e v e l q u e s t i o n s asked by n u r s i n g i n s t r u c t o r s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s . I t may be c o n c l u d e d t h a t the d e s i g n o f the module d i d h e l p the l e a r n e r a c c o m p l i s h the s t a t e d o b j e c t i v e s . I t seems, t h e r e f o r e , t h a t s e l f - i n s t r u c t i o n v i a a p l a n n e d s e r i e s o f l e a r n -i n g a c t i v i t i e s can be an e f f e c t i v e way to l e a r n . The study sample r e p r e s e n t e d f o u r n u r s i n g f a c u l t i e s from t h r e e c o l l e g e s ; two c o l l e g e s s i t u a t e d w i t h i n the G r e a t e r Vancouver a r e a of B r i t i s h Columbia, and one r e g i o n a l c o l l e g e . A l t h o u g h the study sample was s m a l l (n=14), the study does s u p p o r t the c o n c l u s i o n s t h a t the module would be an e f f e c t i v e l e a r n i n g t o o l f o r n u r s i n g i n s t r u c t o r s t e a c h i n g i n B r i t i s h Columbia c o l l e g e s . The r e s e a r c h reviewed i n S e c t i o n 1.1 showed t h a t q u e s t i o n i n g s k i l l i s p e r c e i v e d by s t u d e n t s as an e f f e c t i v e t e a c h e r b e h a v i o r . -61-S e c t i o n 2.1 d e s c r i b e d the purposes o f p o s t - c l i n i c a l c o n f e r e n c e s and reasoned t h a t s t u d e n t s r e q u i r e the use o f h i g h c o g n i t i v e p r o c e s s e s i f they a r e to n u r s e . High l e v e l q u e s t i o n i n g f o s t e r s t h e se p r o c e s s e s . I t seems r e a s o n a b l e to assume, t h e r e f o r e , t h a t r a i s i n g the l e v e l o f q u e s t i o n s asked by i n s t r u c t o r s i s a d e s i r a b l e g o a l . The average p e r -cent o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s i n b o t h groups on the p r e t e s t was 19.7%. The average p e r c e n t o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s i n the e x p e r i m e n t a l group on the p o s t t e s t was 35%. I t may be c o n c l u d e d t h a t i n s t r u c t i o n i n q u e s t i o n i n g i s needed by n u r s i n g i n s t r u c -t o r s and t h a t the s e l f - i n s t r u c t i o n a l module meets t h i s need. U n f o r t u n a t e l y , the second h y p o t h e s i s of t h i s s t u d y , d e s i g n e d to t e s t the e f f e c t o f h i g h l e v e l q u e s t i o n s on the l e v e l o f q u e s t i o n s asked by s t u d e n t s , was abandoned due to i n s u f f i c i e n t d a t a . T h e r e f o r e , no c o n c l u s i o n s can be drawn r e g a r d i n g the e f f e c t o f the i n c r e a s e d l e v e l o f i n s t r u c t o r ' s q u e s t i o n s on s t u d e n t s . The q u e s t i o n c l a s s i f i c a t i o n scheme d e v i s e d f o r t h i s s t u d y and shown i n Appendix C, pages 131-32 , formed the t h e o r e t i c a l base o f the module, and p r o v i d e d the r e f e r e n t f o r the c o d i n g of q u e s t i o n s . The i n t e r -r a t e r r e l i a b i l i t y was 86.7% agreement. I t may be c o n c l u d e d t h a t the c l a s s i f i c a t i o n scheme i s an e f f e c t i v e framework f o r the study of q u e s t i o n s , and f o r the a n a l y s i s of q u e s t i o n s d i r e c t e d toward the c o g n i t i v e domain. -62-6.3 Recommendations A major problem i n t h i s s t u d y was the d i f f i c u l t y i n o b t a i n i n g a sample o f n u r s i n g i n s t r u c t o r s who were w i l l i n g to i n v e s t the time r e q u i r e d to s t u d y the module. A heavy investment of time i s needed i n any l e a r n i n g endeavour, and the number o f hours r e q u i r e d o f the s u b j e c t s , over and above a normal work day, was a d e t e r r e n t . A l t h o u g h the p o s s i b l e reward was the a c q u i s i t i o n o f a t e a c h i n g s k i l l , t h e n u r s i n g i n s t r u c t o r s approached, tended to view the s t u d y as a s t u d e n t p r o j e c t which o f f e r e d l i t t l e b e n e f i t to them. A f u t u r e r e s e a r c h e r , d e s i r o u s o f o b t a i n i n g a sample o f n u r s i n g i n s t r u c t o r s i n o r d e r to o f f e r i n - s e r v i c e e d u c a t i o n , would be w e l l - a d v i s e d to seek o f f i c i a l s a n c t i o n f o r the p r o j e c t , and con-duct such i n - s e r v i c e e d u c a t i o n d u r i n g the i n s t r u c t o r ' s w o r k i n g h o u r s . Should the e d u c a t i o n a l a c t i v i t y be s e l f - i n s t r u c t i o n a l i n n a t u r e , as i t was i n t h i s s t u d y , the r e s e a r c h e r s h o u l d seek time o f f f o r the n u r s i n g i n s t r u c t o r s to p e r m i t t h e i r independent p u r s u i t o f the l e a r n i n g a c t i v i t i e s . I t i s c l e a r , a f t e r a n a l y s i s o f 40 t a p e s , t h a t i n - s e r v i c e educa-t i o n i n the l e a d e r s h i p of p o s t - c l i n i c a l c o n f e r e n c e s i s needed. S e c t i o n 1. opens w i t h the statement t h a t the e d u c a t i o n o f many n u r s i n g i n s t r u c t o r s p r e p a r e d them to n u r s e , not to t e a c h . While the n u r s i n g knowledge and e x p e r t i s e of the i n s t r u c t o r s was e v i d e n t , many c o n f e r e n c e s c o n s i s t e d o f a s t u d e n t r e c i t a l o f t a s k s performed and a d e s c r i p t i o n o f a p a t i e n t ' s d i a g n o s i s , m e d i c a t i o n s o r t r e a t m e n t . Such enumeration o f d a t a does l i t t l e to f o s t e r the c o g n i t i v e p r o c e s s e s r e q u i r e d to n u r s e . In some c a s e s , s t u d e n t d i s c u s s i o n was l i t t l e more than a s o c i a l c h a t . Any s t u d y whose g o a l i s to -63-a s s i s t n u r s i n g i n s t r u c t o r s i d e n t i f y and then d i s p l a y e f f e c t i v e t e a c h i n g b e h a v i o r s i n p o s t - c l i n i c a l c o n f e r e n c e s would be w o r t h w h i l e . T h i s study has shown t h a t the s e l f - i n s t r u c t i o n a l module was e f f e c t i v e i n r a i s i n g the p e r c e n t a g e o f h i g h l e v e l q u e s t i o n s asked by i n s t r u c t o r s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s . F u r t h e r s t u d y i s needed to e x p l o r e whether, a) the l e v e l o f q u e s t i o n s i s m a i n t a i n e d over a p e r i o d of time, b) the l e v e l o f q u e s t i o n s has an e f f e c t on s t u d e n t ' s l e v e l o f q u e s t i o n s , c) the l e v e l o f q u e s t i o n s i s a f a c t o r i n the s t u d e n t ' s assessment o f an i n s t r u c t o r ' s e f f e c t i v e n e s s , d) the l e v e l o f q u e s t i o n s has an e f f e c t on v a r i o u s s t u d e n t b e h a v i o r s , such as performance i n the c l i n i c a l a r e a , e) the l e v e l o f q u e s t i o n s v a r i e s w i t h the i n s t i t u t i o n i n which i n s t r u c t o r s work, f ) the l e v e l o f q u e s t i o n s v a r i e s w i t h the e d u c a t i o n a l p r e p a r a t i o n o f i n s t r u c t o r s . F i n a l l y , i t would be advantageous t o extend t h i s study to i n s t r u c -t i o n i n o t h e r a s p e c t s of q u e s t i o n i n g , such as w r i t i n g e x a m i n a t i o n q u e s t i o n s , p l a n n i n g q u e s t i o n i n g s t r a t e g i e s , and q u e s t i o n s d i r e c t e d toward the a f f e c t i v e domain. - 6 4 -B i b l i o g r a p h y Armington, C a t h e r i n e ; E v o d i a R e i n i k k a and Helen C r e i g h t o n . 1972. "Student e v a l u a t i o n - t h r e a t o r i n c e n t i v e ? " N u r s i n g O u t l o o k 20:789-792. A r n o l d , D a n i e l , Ronald Atwood and V i r g i n i a Rogers. 1973. "An i n v e s t i g a t i o n of r e l a t i o n s h i p s among q u e s t i o n l e v e l , r e s ponse l e v e l and l a p s e time." S c h o o l S c i e n c e and Mathematics 73:591-594. Barham, V i r g i n i a , 1965. " I d e n t i f y i n g e f f e c t i v e b e h a v i o r o f the n u r s i n g i n s t r u c t o r through c r i t i c a l i n c i d e n t s . " N u r s i n g Research 14:65-69. Barnes, C a r o l . 1976. "A d e s c r i p t i v e study o f the q u e s t i o n i n g b e h a v i o r of c o l l e g e i n s t r u c t o r s . " D o c t o r a l d i s s e r t a t i o n , Claremont Graduate S c h o o l . Bloom, Benjamin, ed. 1956. Taxonomy of E d u c a t i o n a l O b j e c t i v e s Handbook  I: C o g n i t i v e Domain. London: Longman Group L t d . Bower, Fay L o u i s e . 1972. The P r o c e s s o f P l a n n i n g N u r s i n g Care. St. L o u i s : The C.V. Mosby Co. B u t l e r , C a r o l and D o r i s G e i t g e y . 1970. "A t o o l f o r e v a l u a t i n g t e a c h e r s . " N u r s i n g O u t l o o k 18:56-58. Campbell, Donald and J u l i a n S t a n l e y . 1963. E x p e r i m e n t a l and Q u a s i - E x p e r i m e n t a l D esigns f o r Research. C h i c a g o : Rand M c N a l l y and Co. C a r i n , A r t h u r and Robert Sund. 1971. D e v e l o p i n g Q u e s t i o n i n g T e c h n i q u e s . A S e l f Concept Approach. Columbis, Ohio: C h a r l e s E. M e r r i l l P u b l i s h i n g Co. C l e g g , Ambrose. 1971. "Classroom q u e s t i o n s . " E n c y c l o p e d i a o f E d u c a t i o n . New York: M a c M i l l a n C l e g g , Ambrose A., e t a l . 1969. "Teacher s t r a t e g i e s o f q u e s t i o n i n g f o r e l i c i t i n g s e l e c t e d c o g n i t i v e s t u d e n t r e s p o n s e s . " Paper p r e s e n t e d a t the American E d u c a t i o n a l Research A s s o c i a t i o n Annual Meeting. C o l e , R i c h a r d and David W i l l i a m s . 1973. " P u p i l r e s p o n s e s to t e a c h e r q u e s t i o n s : C o g n i t i v e l e v e l , l e n g t h and s y n t a x . " E d u c a t i o n a l  L e a d e r s h i p 31:142-145. D a v i s , O.L. and Drew T i n s l e y . 1967. " C o g n i t i v e o b j e c t i v e s r e v e a l e d by c l a s s r o o m q u e s t i o n s asked by s o c i a l s t u d i e s s t u d e n t t e a c h e r s . " Peabody J o u r n a l o f E d u c a t i o n 45:21-26. de Tornyay, Rheba. 1971. S t r a t e g i e s f o r T e a c h i n g N u r s i n g . New York: John W i l e y and Sons, I n c . - 6 5 -D i c k i n s o n , Gary. 1973. T e a c h i n g A d u l t s . O n t a r i o : A l g e r P r e s s . Dixon, Jane and B e v e r l y K oerner. 1976. " F a c u l t y and s t u d e n t p e r c e p t i o n s of e f f e c t i v e c l a s s r o o m t e a c h i n g i n n u r s i n g . " N u r s i n g Research 25:300-305 Dunkin, M i c h a e l and Bruce B i d d l e . 1974. The Study of T e a c h i n g . New York: H o l t , R i n e h a r t and Winston, Inc. Evans, Joseph and Maury M a s s l e r . 1976. " B e h a v i o r a l c h a r a c t e r i s t i c s o f e f f e c t i v e c l i n i c a l t e a c h e r s . " A b s t r a c t . J o u r n a l o f D e n t a l E d u c a t i o n 40:48. F l a n d e r s , Ned. 1970. A n a l y z i n g Teacher B e h a v i o r . Don M i l l s , O n t a r i o : Addison-Wesley P u b l i s h i n g Co. Friedman, Morton. 1974. "A system to a n a l y z e geometry t e a c h e r s ' q u e s t i o n s . " M a thetmatics Teacher 67:709-713. G a l l , M e r e d i t h . 1970. "The use o f q u e s t i o n s i n t e a c h i n g . Review of  E d u c a t i o n a l Research 40:707-721. G a l l a g h e r , J . J . 1965. " E x p r e s s i v e thought by g i f t e d c h i l d r e n i n the c l a s s r o o m . " Elementary English-42:559-568. 1976. I n v o l v i n g Students i n Q u e s t i o n i n g . Boston: A l l y n and Bacon Inc. Godbold, John. 1968. " O r a l q u e s t i o n i n g p r a c t i c e s o f t e a c h e r s i n s o c i a l s t u d i e s c l a s s e s . " U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n : U n i v e r s i t y o f F l o r i d a . H e i d g e r k e n , L o r e t t a . 1965. T e a c h i n g and L e a r n i n g i n S c h o o l s o f N u r s i n g . P h i l a d e l p h i a : J . B. L i p p i n c o t t Co. H i l l , Emma. 1967. "A study o f the v e r b a l i n t e r a c t i o n between master t e a c h e r and s t u d e n t s d u r i n g c l i n i c a l n u r s i n g c o n f e r e n c e s . " U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n : Columbia U n i v e r s i t y . Hunkins, F r a n c i s . 1968. "The i n f l u e n c e of a n a l y s i s and e v a l u a t i o n q u e s t i o n s on achievement i n s i x t h grade s o c i a l s t u d i e s . " E d u c a t i o n a l  L e a d e r s h i p 25:326-332. 1970. " A n a l y s i s and e v a l u a t i o n q u e s t i o n s : t h e i r e f f e c t s upon c r i t i c a l t h i n k i n g . " E d u c a t i o n a l L e a d e r s h i p 3:697-705. 1972. Q u e s t i o n i n g S t r a t e g i e s and Tec h n i q u e s . Boston: A l l y n and Bacon Inc. Jacobson, M a r g a r e t . 1966. " E f f e c t i v e and i n e f f e c t i v e b e h a v i o r o f t e a c h e r s o f n u r s i n g as determined by t h e i r s t u d e n t s . " N u r s i n g R e search 15:218-224. -66-K i k e r , M y r l e n e . 1973. " C h a r a c t e r i s t i c s o f the e f f e c t i v e t e a c h e r . " N u r s i n g O u t l o o k 21:721-723. Lamb, W i l l i a m . 1977. " E v a l u a t i o n o f a s e l f - i n s t r u c t i o n a l module f o r t r a i n i n g s c i e n c e t e a c h e r s to ask a wide c o g n i t i v e v a r i e t y o f q u e s t i o n s . " S c i e n c e E d u c a t i o n 61:29-39. Lowery, B a r b a r a ; Anne Keane and I r w i n Hyman. 1971. " N u r s i n g s t u d e n t s and f a c u l t y o p i n i o n on s t u d e n t e v a l u a t i o n o f t e a c h e r s . " N u r s i n g  Research 20:436-439. Manson, Gary and Ambrose C l e g g . 1970. "Class r o o m q u e s t i o n s : Keys to c h i l d r e n s ' t h i n k i n g ? " Peabody J o u r n a l o f E d u c a t i o n 47:302-307. Matheney, Ruth. 1969. " P r e - and p o s t - c o n f e r e n c e s f o r s t u d e n t s . " American J o u r n a l o f N u r s i n g 69:286-289. Mayberry, W i l l i a m . 1973. "Some dimensions of c l i n i c a l t e a c h i n g . " J o u r n a l o f D e n t a l E d u c a t i o n 37:8-12. Merwin, W i l l i a m and Donald S c h n e i d e r . 1973. "The use of s e l f - i n s t r u c t i o n a l modules i n the t r a i n i n g o f s o c i a l s t u d i e s t e a c h e r s to employ h i g h e r c o g n i t i v e l e v e l q u e s t i o n i n g s t r a t e g i e s . " The J o u r n a l o f E d u c a t i o n a l  Research 67:13-18. Minor, F r a n c e s . 1976. "Toward an a r t - s c i e n c e o f q u e s t i o n i n g : a c r i t i c a l i n q u i r y i n t o a s t r a t e g i c t e a c h i n g f u n c t i o n . " D o c t o r a l d i s s e r t a t i o n . T e achers C o l l e g e , Columbia U n i v e r s i t y . U n i v e r s i t y m i c r o f i l m s number 70-12525. Myers, B e t t y . 1977. " B e l i e f s o f d e n t a l f a c u l t y and s t u d e n t s about e f f e c -t i v e c l i n i c a l t e a c h i n g b e h a v i o r s . " J o u r n a l o f D e n t a l E d u c a t i o n 41:68-76. McCann, E l i z a b e t h . 1959. " C r i t i c a l r e quirements o f nurse t e a c h e r s i n s e l e c t e d u n i v e r s i t y s c h o o l s o f n u r s i n g . " M a s t e r s t h e s i s , Wayne S t a t e U n i v e r s i t y . McDonald, F r e d e r i c k J . 1972. " E v a l u a t i o n o f t e a c h e r b e h a v i o r . " In Houston, Robert and Robert Hewsam, eds. Competency Based Teacher E d u c a t i o n . USA: S c i e n c e Research A s s o c i a t e s I n c . Pars o n s , T. W. 1968. Guided s e l f - a n a l y s i s system f o r p r o f e s s i o n a l d e v e l o p - ment e d u c a t i o n s e r i e s - t e a c h i n g f o r i n q u i r y . B e r k e l e y : U n i v e r s i t y of C a l i f o r n i a . Q u i r i n g , J u l i a . 1971. "The e f f e c t s o f q u e s t i o n i n g l e v e l and feedback t i m i n g on the achievement of sophomore n u r s i n g s t u d e n t s u s i n g an a u t o - t u t o r i a l approach." U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n : The U n i v e r s i t y o f Washington. R i e g l e , Rodney. 1976. " C l a s s i f y i n g c l a s s r o o m q u e s t i o n s . " J o u r n a l o f Teacher E d u c a t i o n 17:156-161. -67-Sanders, N o r r i s . 1966. C l a s s r o o m Q u e s t i o n s - What Ki n d s ? New York: Harper and Row. S c h o l d r a , Joanne. 1972. "The e f f e c t o f an e x p e r i m e n t a l q u e s t i o n i n g s t r a t e g y i n c l i n i c a l c o n f e r e n c e s and e v a l u a t i o n i n t e r v i e w s on the achievement o f n u r s i n g s t u d e n t s . " U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n . U n i v e r s i t y o f Washington. S c h o l d r a , Joanne and J u l i a Q u i r i n g . 1973. "The l e v e l o f q u e s t i o n s posed by n u r s i n g e d u c a t o r s . " J o u r n a l of N u r s i n g E d u c a t i o n 12:15-20. Schweer, Jean and K r i s t i n e Gebbie. 1976. C r e a t i v e T e a c h i n g i n C l i n i c a l  N u r s i n g . S t . L o u i s : The C.V. Mosby Co. Stevens, Romiett. 1912. "The q u e s t i o n as a measure o f e f f i c i e n c y i n i n s t r u c t i o n : A c r i t i c a l s tudy of c l a s s r o o m p r a c t i c e . " Teachers  C o l l e g e C o n t r i b u t i o n s to E d u c a t i o n No. 48. Walker, J . D. 1971. " F a v o r a b l e and u n f a v o r a b l e b e h a v i o r s i n the d e n t a l f a c u l t y as e v a l u a t e d by d e n t a l s t u d e n t s . " J o u r n a l of D e n t a l  E d u c a t i o n 35:33-39. Welch, H. E. 1976. "The e f f e c t s o f a s e l f - i n s t r u c t i o n a l l e a r n i n g program on the o r a l q u e s t i o n i n g b e h a v i o r o f s o c i a l s t u d i e s s t u d e n t t e a c h e r s . " U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n : E a s t Texas S t a t e U n i v e r s i t y . Y u r a , H e l e n and Mary Walsh. 1973. The N u r s i n g P r o c e s s . New York: A p p l e t o n - C e n t u r y - C r o f t s . Z i g l e r , C a l v i n . 1972. "A comparative study of the e f f e c t i v e n e s s of two s e l f - i n s t r u c t i o n a l l e a r n i n g packages used to t r a i n i n t e r n t e a c h e r s i n q u e s t i o n i n g s t r a t e g i e s . " U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n : U n i v e r s i t y o f Oregon. -68-APPENDIX A E x p l a n a t o r y L e t t e r to P r o s p e c t i v e V o l u n t e e r s -69-Dear I am a n u r s e and c u r r e n t l y a graduate s t u d e n t i n e d u c a t i o n a t the U n i v e r s i t y o f B r i t i s h Columbia. For my t h e s i s I am d e s i g n i n g a s e l f - i n s t r u c t i o n a l module to a s s i s t n u r s i n g i n s t r u c t o r s t o enhance t h e i r q u e s t i o n i n g s k i l l s d u r i n g p o s t - c l i n i c a l c o n f e r e n c e s . I b e l i e v e t h a t t h i s module w i l l h e l p i n s t r u c t o r s i n t h e i r d i f f i c u l t t a s k o f t e a c h i n g s t u d e n t s to i n t e g r a t e t h e i r c l i n i c a l e x p e r i e n c e s and r e l a t e them to c l a s s r o o m t e a c h i n g and t h e o r y . E v e n t u a l l y the module w i l l be a v a i l a b l e to n u r s i n g i n s t r u c -t o r s throughout the p r o v i n c e . While s i m i l a r modules have been d e v e l o p e d f o r t e a c h e r s i n o t h e r f i e l d s and have proven to be e f f e c t i v e , the module i n q u e s t i o n f o r n u r s i n g i n s t r u c t o r s i s s t i l l i n the dev e l o p m e n t a l stage and i t s e f f e c t i v e n e s s must be t e s t e d . I t i s i n o r d e r to conduct t h i s t e s t t h a t I am r e q u e s t i n g your p a r t i c i p a t i o n . The b e n e f i t s to you w i l l r e l a t e to your s k i l l s as an e f f e c t i v e q u e s t i o n e r ; the b e n e f i t s to m y s e l f w i l l be the c o m p l e t i o n o f my t h e s i s and the module. Below i s a d e s c r i p t i o n o f the commitment I am a s k i n g o f you. 1. You w i l l be asked to s u p p l y me w i t h an a u d i o t a p e o f a p o s t -c l i n i c a l c o n f e r e n c e on two o c c a s i o n s ; the f i r s t time f o l l o w i n g your acknowledgement o f t h i s l e t t e r and the second time about two months l a t e r . B lank tapes w i l l be p r o v i d e d . 2. You w i l l r e c e i v e the module a f t e r one o f your r e c o r d i n g s , e i t h e r the f i r s t one o r the second one. Completion o f the module w i l l r e q u i r e a p p r o x i m a t e l y f i v e hours o f your time. I t may be s t u d i e d -71-I n s t r u c t i o n s f o r T a p i n g In o r d e r to t e s t the e f f e c t i v e n e s s o f the module, I r e q u i r e two a u d i o -tapes o f p o s t - c l i n i c a l c o n f e r e n c e s conducted by y o u r s e l f . You w i l l r e c e i v e the module a f t e r one r e c o r d i n g - e i t h e r the f i r s t o r the second. What to Record 1. The p o s t - c l i n i c a l c o n f e r e n c e s h o u l d be one d e s i g n e d f o r s t u d e n t s t o p r e s e n t n u r s i n g c a r e p l a n s o r p r o c e s s e s , o r to r e l a t e c l i n i c a l e x p e r -i e n c e s to c l a s s r o o m t e a c h i n g and n u r s i n g t h e o r y . I t s h o u l d not be one i n which new s t u d e n t s a r e b e i n g o r i e n t e d , o r one f o l l o w i n g an unusual e x p e r i e n c e . 2. Be p r e p a r e d to conduct the d i s c u s s i o n and ask q u e s t i o n s i n your u s u a l way. T a p i n g P r o c e d u r e 1. E x p l a i n to the s t u d e n t s t h a t you w i l l be r e c o r d i n g the d i s c u s s i o n and t h a t the tape w i l l be used to h e l p you to improve your t e a c h i n g . 2. Make s u r e the tape r e c o r d e r i s working and t h a t everyone can be hea r d . 3. Record a t l e a s t t h i r t y minutes o f i n s t r u c t o r d i r e c t e d d i s c u s s i o n . 4. The d e s i r e d tape s h o u l d c o n t a i n b o t h i n s t r u c t o r and s t u d e n t ' s t a l k . - 7 3 -NAME: EMPLOYING AGENCY: HOME ADDRESS: PHONE: WORK ; HOME CLINICAL AREA: AGENCY: EDUCATIONAL BACKGROUND: RN - YEAR OBTAINED: INSTITUTION: BSN - YEAR OBTAINED: INSTITUTION: OTHER QUALIFICATIONS: WORK EXPERIENCE: CLINICAL YEARS TEACHING YEARS PLEASE LIST THE NAME OF ANY COURSES YOU MAY HAVE TAKEN FROM THE FACULTY OF EDUCATION: I am w i l l i n g to p a r t i c i p a t e i n the t e s t i n g o f a s e l f - i n s t r u c t i o n a l module f o r n u r s i n g i n s t r u c t o r s . I am p r e p a r e d to r e c o r d two o f my p o s t - c l i n i c a l c o n f e r e n c e s w i t h s t u d e n t s and g i v e the tapes to Jenny C r a i g . I un d e r s t a n d t h a t the stu d y o f the module w i l l r e q u i r e f i v e hours o f my time. I have been a s s u r e d t h a t my name w i l l not appear i n any w r i t t e n r e p o r t . S i g n e d : Return t o : Jenny C r a i g c/o D i v i s i o n of E d u c a t i o n a l Support & Development O f f i c e o f the C o - o r d i n a t o r o f H e a l t h S c i e n c e s Room 408, I n s t r u c t i o n a l Resources C e n t r e U n i v e r s i t y o f B r i t i s h Columbia Vancouver, B. C. AGE: POSTAL CODE: -74-APPENDIX B Examples of Transcribed Question Sheets - 7 5 -S u b j e c t 01 P o s t t a p e T = Teacher S = Student T What do we mean by s e n s o r y s t i m u l a t i o n ? T What are your senses? T When we're t a l k i n g about s e n s o r y s t i m u l a t i o n , what do we mean? S How the environment i s a f f e c t e d o r how i t a f f e c t s ? T Have you had a p a t i e n t whose senses have been a f f e c t e d ? Can you g i v e me an example? T Anyone e l s e got an example? T Have you had any examples o f how the environment w i t h such t h i n g s as n o i s e and odour have a f f e c t e d your p a t i e n t ? T D i d anyone have a p a t i e n t who was a f f e c t e d by the space o r the room equipment around them? T What k i n d s o f t h i n g s can you do t o s t i m u l a t e t h e se senses? T D i d you do a n y t h i n g s p e c i f i c to s t i m u l a t e the sense o f s m e l l ? T T h i n k i n g back to d o i n g your assessment, what k i n d o f t h i n g s d i d you l o o k f o r o r ask about so t h a t you c o u l d a s s e s s the senses a c c u r a t e l y ? T Any o t h e r t h i n g s l i k e t h a t ? T What about c h e c k i n g out t h e i r sense o f touch? T D i d anyone have a c l i e n t who had a problem w i t h sense o f touch? T D i d anyone have someone who c o u l d n ' t f e e l ? S D i d your l a d y , Mrs. R., c o u l d she f e e l ? T Was she a b l e to f e e l o r touch? S M e d i c a t i o n s would a f f e c t how they a r e a b l e to touch wouldn't they? S Wouldn't i t a f f e c t more the way they respond to what they f e e l ? T Were any o f you c o n s c i o u s o f changing your p a t i e n t ' s u n i t i n o r d e r to accommodate these senses? What d i d you do? - 7 6 -S u b j e c t 08 P r e t a p e T = Teacher S = Student S Do you know what m a n i c - d e p r e s s i o n i s ? T Do pe o p l e u n d e r s t a n d what C. i s t a l k i n g about? S Has she improved? What changes have you seen? S What i s she g o i n g home to now? S Her husband w i l l be t h e r e , and her c h i l d r e n ? S So she's not s t a c k i n g t h i n g s i n p l a c e s ? S W i l l she be on m e d i c a t i o n s when she r e t u r n s home? S You mentioned she's been d i s o r g a n i z e d . Has she been l i k e t h a t e v e r s i n c e she came to the ward? S How do you f e e l s h e ' l l view home now C ? S What's the r e l a t i o n between d i s o r g a n i z a t i o n and h e r d i a g n o s i s ? T Have p e o p l e got a c l e a r i d e a from C. what she was l i k e when she came i n t o h o s p i t a l ? T Who knows some o t h e r t y p i c a l b e h a v i o r s ? T Do you want to get i n t o some n u r s i n g care? S In the d o c t o r ' s n o t e s , they mentioned s c h i z o p h r e n i a . I j u s t wondered why they threw t h a t i n ? S No examples? T How do you d e a l w i t h someone who's d e l u s i o n a l ? T How do you do t h a t ? (Reduce a n x i e t y . ) S What about r e d u c i n g the s e n s o r y i n p u t ? T Key word. Low s t i m u l a t i o n . What does t h a t mean? T How do you lower s t i m u l a t i o n ? T What a r e your senses? -77-S u b j e c t 09 F r e t a p e T = Teacher S = Student T N. do you want to e x p l a i n what your l o n g term g o a l i s f o r B i l l ? T D. your p a t i e n t has K a s a k o f f ' s too so you're f a m i l i a r w i t h these p a t t e r n s too? T Where i s h i s mother now? T How d i d you break t h a t down i n t o a s h o r t term g o a l f o r your c a r e p l a n ? T a l k a l i t t l e about t h a t . T How d i d he respond to the i d e a o f h a v i n g h i s p i c t u r e taken? T Do you t h i n k i t f i t s h i s needs from what she s a i d ? T S. do you want to g i v e M. any feedback about h e r l o n g term g o a l ? T How about the s h o r t term g o a l , does t h a t meet the r e q u i r e m e n t s f o r b e i n g measurable and s p e c i f i c ? T What about the m e a s u r a b i l i t y , does t h a t sound okay? T What does t h a t do - p l a n n i n g time l i k e t h a t - i n terms o f what you know about changing b e h a v i o r s ? T (Long term g o a l . ) Does t h a t sound r e a l i s t i c ? S Has B i l l e v e r gone to music therapy? S And you can get him to j o i n i n t h i n g s ? S Does he remember, week by week, i n o r d e r t o a n t i c i p a t e i t ? T Why would you ask him to go to the p o o l room w i t h o u t t e l l i n g him where he was going? T Have you n o t i c e d t h a t when he's been away from the a r e a and brought back to the day room t h a t he tends to be more d i s o r i e n t e d ? T Do you t h i n k he would remember i f someone were to show him? Is i t because he h a s n ' t p l a y e d f o r so l o n g o r i s i t because h i s memory i s f a i l i n g ? -78-S u b j e c t 17 P r e t a p e T = Teacher S = Student T What i s r e s p i r a t o r y f a i l u r e ? T What has u s u a l l y gone on? T What's a n o t h e r d i s e a s e t h a t causes t h a t ? T C h r o n i c b r o n c h i t i s . What happens t h e r e ? T The word ( b r o n c h i t i s ) t e l l s you what? T What e l s e do you get because of i n f l a m m a t i o n ? T You've got a narrow airway and what happens? T What's the t h i r d c o n d i t i o n t h a t makes up C.O.L.D.? T Asthma. And what c h a r a c t e r i s e s t h a t ? T There's one predominant problem i n r e s p i r a t o r y f a i l u r e ? You've s a i d h y p o x i a . What e l s e ? T Mr. Z. i s i n r e s p i r a t o r y a c i d o s i s almost a l l o f the time. What then would you e x p e c t h i s b l o o d gases to show? T D i d anyone p i c k up the v e r y lowest pH he showed? S How low can a pH go? T What about PC0 2? T What d i d you see as a number? T What was h i s 0 2 d o i n g a l l t h i s time? S Why d i d they take a venous sample? T What would t h a t suggest? T T. remind us about the oxygen d i s s o c i a t i o n curve? S How would t h a t a f f e c t the 0 2 d i s s o c i a t i o n curve? S There wouldn't be a chance of ( c o u l d n ' t h e a r ) ? S Does p o l y c y t h e m i a always r e f e r to mature r e d b l o o d c e l l s ? T The normal b i c a r b o n a t e i s ? -79-T Why wouldn't i t go up? T I t d i d n ' t go up as much as the PCC^. Why not? T I f you had a h i g h PCC^ l e v e l how would you respond? T You'd be d e p r e s s e d . What e l s e would you be? T He doesn't show these s i g n s . Why not? -80-S u b j e c t 22 P o s t t a p e T = Teacher S = Student T C. do you know a n y t h i n g about t h i s p a t i e n t ' s p a s t h i s t o r y ? T What i s the purpose o f the pacemaker? T What i s n i t r o - g l y c e r i n e ? T What i s i t g i v e n f o r ? T Does i t d i l a t e any p a r t i c u l a r a r t e r y ? T What k i n d s o f m e d i c a t i o n does he get? T Why i s he g i v e n these m e d i c a t i o n s ? T Has he got any edema? T He's not on d i g o x i n i s he? S Doesn't i t d e c r e a s e the volume? T Have you n o t i c e d any edema on him? T What a r e the n u r s i n g r e s p o n s i b i l i t i e s when a p a t i e n t i s on L a s i x ? T What o t h e r drug i s g i v e n w i t h L a s i x ? T Give me examples o f p o t a s s i u m r i c h foods? S What a r e the s i g n s o f hypokalemia? T What's the normal serum potassium? T What's the p a t i e n t ' s e d u c a t i o n a l l e v e l ? S You wouldn't l e t a p a t i e n t who hadn't had a h e a r t a t t a c k hear the tapes would you? T Has anyone l i s t e n e d to t h a t tape? T How would you use those books f o r your p a t i e n t ? T Can you r e c a l l r i s k f a c t o r s ? S Which number i s t h a t ? S On t h i s f l o o r do they j u s t have tapes f o r h e a r t a t t a c k ? S Is t h e r e a copy o f t h a t a t the c o l l e g e ? - 8 1 -APPENDIX C The S e l f - I n s t r u c t i o n a l Module -83-Q U E S T I O N I N G FOR C L I N I C A L N U R S I N G I N S T R U C T O R S -84-) 1978 J , C r a i g F o r r e s e a r c h purposes o n l y . - 8 5 -Q u e s t i o n i n g  f o r C l i n i c a l N u r s i n g I n s t r u c t o r s Produced by Jennifer Craig, R.N., B.S.N. Advisory Committee Gordon Page, Ed.D., Dire c t o r , D i v i s i o n of Educational Support and Development, Health Sciences, U.B.C. Walter Boldt, Ph.D., Professor, Faculty of Education, U.B.C. Marilyn Willman, Ph.D., Professor, D i r e c t o r , School of • Nursing, U.B.C. F i n a n c i a l Support Province of B r i t i s h Columbia Seasonal Employment (University) Programme Cover Design Pat Parsons -86-Acknowledgements The author's heartfelt thanks go to: Gordon Page and the advisory committee for their continual support and encouragement Elizabeth Bregg for her nurturance. Elizabeth McCann and Elizabeth Will for their helpful suggestions. Barbara Bradley, Norma Foster, Valerie Sproule and Debbie Taylor for their willingness to be guinea pigs. Julia Quiring for her influence. -87-Table of Contents P a g e What Is this? 5 What is the content? 7 Major Objectives 11 Unit I 15 Learning Activity One 17 Learning Activity Two 19 Learning Activity Three 21 Learning Activity Four 39 Unit II 53 Learning Activity Five 55 Learning Activity Six 67 Learning Activity Seven 79 Unit III 93 Learning Activity Eight 95 Learning Activity Nine 106 Annotated Bibliography 111 -88-W H A T IS THIS -89-What is this? This i s a module. A module i s a self-contained s e r i e s of planned a c t i v i t i e s designed to help the learner accomplish c e r t a i n well-defined learning objectives. Who is it for? Instructors of Nursing. This module i s designed for c l i n i c a l nursing i n s t r u c t o r s who teach i n two year college pro-grammes within the Province of B r i t i s h Columbia. What is its purpose? To help you improve your questioning s k i l l s . The purpose of th i s module i s to help you improve your o r a l questioning s k i l l s when you are conducting p o s t - c l i n i c a l conferences. - 9 0 -W H A T IS T H E CONTENT -91-The a b i l i t y to ask thought-provoking questions i s one of the h a l l -marks of an effective teacher. Research studies of the characteristics of an effective nursing instructor have identified s k i l l in questioning time and time again. However, many nursing instructors have never been taught questioning strategies. This module has been designed for you to teach yourself some elements of questioning. Only "some"? Yes. There are many elements in a questioning strategy. This module deals with the relationships of questions to levels of cognitive thought and how this knowledge can be applied during post-clinical conferences. If you become interested in the topic, the bibliography at the end of this booklet w i l l direct you to further sources of information. A question i s usually taken to be an interrogative sentence. In addi-tion, the word "question" i s used in this module to include any request by a teacher calling for an intellectual or cognitive response on the part of the student. For example: presentation of a problem; a project. -92-A Word About Cl i n i c a l Conferences The post-clinical conference may be defined as a discussion conducted by the instructor with a l l students for whom she has been responsible, following the experience in the c l i n i c a l area. The purposes of these conferences are many and may be briefly summarized as: 1. To relate experiences in the c l i n i c a l area to classroom teaching and nursing theory. 2. To present nursing care plans and processes for analysis and evaluation. 3. To share thoughts, feelings and concerns. The instructor i s faced with the d i f f i c u l t task of helping students to integrate their varied experiences and to c l a r i f y the relationship between them and content presented in the classroom. The instructor i s also expected to help a student cope with her emotions as she meets people in conditions she feels i l l -equipped to handle. This module deals with one small aspect of the total teaching strategy required to conduct a conference - the a b i l i t y to ask thought-provoking questions. The questioning scheme proposed i s directed only toward the intellectual develop-ment of the student. The fostering of values, the socialization of the student into the nurse role, group climate and a l l the other facets of a post-clinical conference are not considered. -93-Taping a Conference In the f i n a l section of this module, you w i l l be asked to analyse an audiotaped conference conducted by yourself. It i s advisable to plan now to obtain a recording before you begin to work through this module. Here is a suggested taping procedure. What to Record 1. The post-clinical conference you record should be one designed to serve purposes 1 and 2 listed on the previous page. It should not be one in which new students are being oriented, or one following an unusual experience. 2. Be prepared to conduct the discussion and ask questions in your usual way. Taping Procedures 1. Explain to the students that you w i l l be recording the discussion in order to analyse your teaching behavior. 2. Make sure the tape recorder is working and that everyone in the group can be heard. 3. Record at least 30 minutes of Instructor directed discussion. 4. The desired tape should contain both instructor and student talk. -94-MAJOR OBJECTIVES -95-Leaim ing Objectives The following are the major learning objectives for this module. They w i l l give you an idea of the instructional intent. When you have complete this module you w i l l be able to: 1. Classify questions in terms of the levels of Bloom's Taxonomy of intellectual processes. 2. Generate questions at each level of Bloom's Taxonomy. 3. Evaluate questions asked during post-clinical conferences. -96-This module is divided into three units, one for each major learning objective. Each unit contains: 1. Specific objectives for the unit. 2. What materials you w i l l need, e.g., a tape recorder. 3. A prospect of the unit. 4. Learning a c t i v i t i e s , e.g., read, answer a question, write something. 5. An estimated time to complete the unit to assist you to plan your time. Of course, these are only rough estimates as each person's situation w i l l vary. 6. A summary of the unit. -97-UNIT ONE Unit I Major Objective: When you have completed this unit, you w i l l be able to classify questions in terms of the levels of Bloom's Taxonomy of intellectual processes. Specifically, you w i l l : 1. Define the term "taxonomy". 2. L i s t the levels of Bloom's cognitive domain. 3. Describe the levels of Bloom's Taxonomy as i t relates to questions. 4 . Allocate selected questions to levels of Bloom's Taxonomy. Resources Needed None. Estimated Time to Complete One - two hours. Prospect of Unit I In this unit you w i l l be introduced to Bloom's Taxonomy as i t relates to levels of intellectual processes and to how questions may be used to foster these processes. This part of the module i s probably the most exacting but i t is a necessary base for what i s to follow. After reading the descriptions of the six levels of the Taxonomy, you w i l l be given sets of questions to allocate to a cognitive level. Your learning of the levels of Bloom's Taxonomy w i l l be reinforced by these exercises. - 9 9 -LEARNING ACTIVITY ONE Briefly look at the chart on page 50 which presents a summary of this unit. Before we explain what we think a taxonomy i s , describe what you think a taxonomy i s . N.B. It is best to WRITE OUT your answers i f you are to learn from this module. A line across the corner i s a sign to turn the page for our answer. -100-Originally Intended to classify biological phenomena into categories such as genus, species, class, etc., the word is now used to denote any class-i f i c a t i o n of things into categories. In education Benjamin Bloom and others have attempted to classify the goals or objectives of education. The result of their work is the Taxonomy of  Educational Objectives: Book I Cognitive Domain. Bloom postulates the existence of six intellectual processes and cl a s s i f i e s them into levels. The goals of education can be directed to each level in order to foster c r i t i c a l thinking. -101-LEARNING ACTIVITY TWO The six intellectual or cognitive levels are: As you can see from the arrangement of the diagram, the levels form a hierarchy. In other words, the lowest level, knowledge, is necessary before the next level, comprehension, can be attained, and so on. In order to operate at the highest level - evaluation - mastery of the previous five levels i s necessary. -102-Memorise the names of the six cognitive levels presented on the previous page. Without referring to the previous page, f i l l in the levels in the diagram below. The classification scheme for questions in this module is based on Bloom's Taxonomy. We have therefore assumed that: 1. there are six levels of cognitive thought, and 2. the six levels form a hierarchy. To encourage students to think, a teacher asks questions that require thought at the highest cognitive levels in order to answer them. Research has shown that, although teachers want to promote c r i t i c a l thinking, the majority of the questions they ask are at the lowest cognitive levels and require only know-ledge or comprehension to answer them. -103-LEARNING A C T I V I T Y THREE The following pages describe the six levels of cognitive thought in more detail and how questions relate to each level. The levels are subdivided into: 1.0 KNOWLEDGE Kl Knowledge of specifics K2 Knowledge of ways and means of dealing with specifics K2.1 Knowledge of conventions K2.2 Knowledge of trends and sequences K2.3 Knowledge of classifications and categories K2.4 Knowledge of cr i t e r i a K2.5 Knowledge of methodology K3 Knowledge of universals and abstractions in a fi e l d 2.0 COMPREHENSION CI Translation C2 Interpretation C3 Extrapolation 3.0 APPLICATION 4.0 ANALYSIS Anl Analysis of elements An2 Analysis of relationships 5.0 SYNTHESIS 51 Production of a unique communication 52 Production of a plan or proposed set of operations 6.0 EVALUATION -104-The following descriptions of the levels of cognitive thought have been adapted from Bloom, Benjamin (editor) Taxonomy of Educational Objectives  Book 1 Cognitive Domain. London, Langman Group Ltd., 1956. -105-1.0. KNOWLEDGE Kl. Knowledge of Specifics Questions at this level emphasise the recall of facts. However, this does not mean that these are poor questions as facts provide the data base on which the student builds a b i l i t i e s to analyse and synthesise. The effectiveness of questions at this level depend upon the objectives the instructor i s attempt-ing to meet. Knowledge questions are easy to think of but the reason for such questions should always be clear. Examples: 1. How many milligrams are there in a gram? 2. Name the valves of the heart. K2. Knowledge of Ways and Means of Dealing with Specifics The second major division of the knowledge category is concerned with a knowledge of the ways of organizing, studying, judging and c r i t i c i z i n g . The stress i s not on the recall of facts alone but rather on the processes of dealing with facts. This division has five subdivisions. K2.1. Knowledge of Conventions Questions at this level demand a reca l l of the characteristic or accepted ways of dealing with various types of information or situations. Examples: 1. What is the correct way to bag isolation linen? 2. How would you pronounce a-p-h-a-s-i-a? K2.2. Knowledge of Trends and Sequences Questions request knowledge of the processes, directions and movements of phenomena with respect to time. Only recognition of the trend is called for - not understanding. Examples: 1. What can you say about the increased incidence of cardiovascular disease in Canada? 2. How did the discovery of p e n i c i l l i n affect mortality rates in Canada? -106-K2.3. Knowledge of Classifications and Categories Questions are directed toward knowledge of the classes, sets, divisions and arrangements which are regarded as fundamental for a given subject f i e l d , purpose argument or problem. Students are not asked to do anything with the divisions but merely re c a l l classifications or categories. Examples: 1. How many types of leukaemia are there? 2. What are two classifications of asepsis? (3. List the categories in Bloom's Taxonomy!) K2.4. Knowledge of Criteria Questions require recall of the cr i t e r i a used to judge or test facts, principles, opinions and conduct. Use of the cr i t e r i a in problem situations constitutes Evaluation. Examples: 1. What cr i t e r i a are used to determine a person's e l i g i b i l i t y for admission to an Extended Care Unit? 2. What are the c r i t e r i a for assessing when the second stage of labour has been reached? K.2.5. Knowledge of Methodology Questions under this subdivision are designed to establish the students knowledge of the methods of inquiry, techniques and procedures, not her abi l i t y to apply them. Examples: 1. What steps did the team leader take to test the patency of the naso-gastric tube? 2. If a nurse i s required to take a wound culture, what would be her f i r s t action? -107-K3. Knowledge of the Unlversals and Abstractions in a Field The third major division of the knowledge category deals with know-ledge of principles and generalizations, and knowledge of theories and structures. The student may be expected to state a theory or rec a l l a generalization at this level. Questions at higher levels may ask her to apply these theories or even formulate one of her own. Questions at this level determine the possession of knowledge - the abil i t y to use i t does not necessarily follow. Examples: 1. What principles underlie the use of traction for a fractured femur? 2. Several divergent opinions exist as to the cause of obesity. What theories have been suggested? -108-KNOWLEDGE Questions directed toward the KNOWLEDGE level require RECALL or recognition of information by the student. Although more than rote memory is required, the information e l i c i t e d i s not very different from that originally learned. KEY CONCEPTS MEMORY KNOWLEDGE REPETITION DESCRIPTION -109-i 2.0. COMPREHENSION The comprehension level represents the lowest level of understanding. When a student i s confronted with a message in either verbal or written form, she i s expected to understand and make some use of the ideas contained within i t . At this level she i s not expected to relate these ideas to others nor to see the f u l l implications of the ideas. There are three divisions of questions in the comprehension category. CI. Translation Questions test the student's competence i n translating or paraphrasing a communication from one form to another without losing accuracy of meaning. Accuracy in translation i s dependent upon prerequisite knowledge. Examples: 1. What does "pro re nate" mean in English? 2. Nurses are currently discussing the "Quality Assurance Program." What does this expression mean? C2. Interpretation Questions focus on the student's a b i l i t y to comprehend the major ideas within a communication and understand the relationships between them. The relationships may be cause and effect, between a definition and an example and a generalization and supporting evidence. Examples: 1. What may have caused your patient to vomit? 2. If a nursing intervention is defined as "a nurses action to i n i t i a t e change in a patient's condition", give an example. - 1 1 0 -C3. Extrapolation Questions at the third sub-category of comprehension ask the student to not only translate and interpret, but to expand the information a step further. She may be asked to f i l l in gaps in her data or predict the consequences of a course of action while, at the same time, recognising the limitations of drawing inferences. Examples: 1. what might happen i f you gave an intramuscular injection in the lower outer quadrant of the buttock? 2 . What did you conclude after weighing the patient? -111-COMPREHENSION Questions directed toward the comprehension level require UNDERSTANDING by the student. KEY CONCEPTS EXPLANATION COMPARISON ILLUSTRATION -112-3.0. APPLICATION The third level of Bloom's categories of the cognitive domain i s application. Questions at this level ask students to apply their knowledge and understanding to situations without specific directions from the teacher. The student i s expected to use her information to solve problems she has not en-countered before. A return demonstration following instruction of a technical procedure would not f a l l into this category; i t would demonstrate comprehension but not application. Later, the student may apply this technical s k i l l in a different situation. Examples: 1. You have stated that an Important learning principle i s immediate feedback. How w i l l you apply this principle when you teach your patient? 2 . Chart your observations using the S.O.A.P. approach. -113-APPLICATION Questions directed toward the application level require SOLVING by the student. KEY CONCEPTS SOLUTION APPLICATION NEW SITUATION -114-4.0. ANALYSIS Analysis requires more sophisticated Intellectual s k i l l s than does comprehension and application. In comprehension, a grasp of meaning i s required. In application, the remembering and using of knowledge in a new situation i s called for. Analysis requires the breakdown of a message or situation into i t s component parts, and detecting the interrelationship and organization of these parts. Analysis is the prerequisite for evaluation. There are two sub-categories of analysis. Anl. Analysis of Elements Questions at this level are asking for identification of the elements in a communication or of events that have occurred. The student i s required to distinguish facts from hypotheses or opinions, and to recognize unstated assump-tions. Examples: 1. What values are traditionally prized in his culture that may have some bearing on his behavior? 2. What are some of the significant observations you made that led you to believe there was a complication? An2. Analysis of Relationships Once elements in a communication or a set of events have been identified, the student must then determine the connections between them. Questions ask students to identify consistencies or inconsistencies in the flow of ideas or events, and to display inductive or deductive reasoning. Inductive reasoning results in a general statement being made on the basis of particular examples and evidence. Deductive reasoning allows inferences to be drawn from general state-ments or applies what i s true in one instance to what i s true in another related instance. Examples: 1. You have identified some values of his culture. Does i t follow that these may affect his behavior while he i s a patient? 2. Last week you had a lecture on maternal-child bonding. Analyze your patient's behavior in terms of this theory. -115-ANALYSIS Questions directed toward the analysis level require EXPLORATION OF REASONING by the student. KEY CONCEPTS INDUCTION DEDUCTION LOGICAL ORDER -116-5.0. SYNTHESIS The f i f t h level of Bloom's Taxonomy i s synthesis. In order to synthe-size students must use the lover four levels of cognition, though not necessarily in order. They must have recalled and comprehended knowledge, applied i t to their task and analysed the situation. The process may be cyclical or errant but the result i s the production of a unique communication, a plan or a set of abstract relations. Time is needed by the student before questions at this level can be answered. 51. Production of a Unique Communication The student is required to produce a communication in which she tries to express ideas and feelings that are unique to her. Questions directed to this level determine the student's a b i l i t y to describe a personal experience in effec-tive English, write, or develop a script. While there are no specifications for the quality of the reply, the student i s expected to demonstrate use of the four lower levels of thought to arrive at an answer. "It would be gross" as an answer to Example 1 does not demonstrate synthesis. Examples: 1. If you had to have a permanent colostomy, how would i t affect your lifestyle? 2. Write a short script that illustrates use of effective Interpersonal s k i l l s by a nurse with a dying patient. 52. Production of a Plan At this level students are required to produce a plan or a solution to a particular problem. The plan must satisfy the requirements of the task but otherwise there is a considerable leeway for the student to use her own ideas. Production of a nursing care plan f a l l s into this category. Examples: 1. If you wanted to find out whether Method A for the treatment of pressure sores is better than Method B, how would you set about it? 2. How do you plan to teach this mother how to care for the baby's cord. -117-SYNTHESIS Questions directed toward this level require CREATING by the student. KEY CONCEPTS PRODUCTIVE THINKING NOVELTY -118-6.0. EVALUATION Evaluation i s the sixth category of the cognitive domain. Although i t is at the top of the hierarchy, Bloom recognises that i t i s not necessarily the last step in thinking. Evaluation may precede an attempt to gain knowledge and comprehension about a communication or situation judged to be ineffective. However, for the purpose of question asking, evaluation w i l l be considered the fina l stage. Evaluation questions ask students to make a judgement about something based on c r i t e r i a . While i t i s a democratic principle that each person i s entitled to her opinion, approval or disapproval are not the answers being sought from nursing students engaged in learning the practice of a sci e n t i f i c discipline. In being asked to judge the value of something, the student i s expected to know i t s purpose, differentiate between facts and values associated with i t , analyse i t for logical accuracy and consistency, compare i t with a standard or something else similarly analysed, and fi n a l l y reach a judgement based on these or other established c r i t e r i a . Examples: 1. To what extent does the nursing care this patient has been receiving meet the standards set by the hospitals Quality Assurance Committee? 2 . Which of the methods used to relieve this patient's pain are the most effective? -119-EV ALU AT ION Questions directed toward this level require JUDGING by the student. KEY CONCEPTS JUDGEMENT SELECTION -120-LEARNING ACTIVITY FOUR The following pages l i s t four sets of questions. Identify each question as being one of the following: Kl CI Ap Anl SI E K2 C2 An2 S2 K3 C3 Answers are given at the back of each set. -121-You may disagree with the answers given. It i s important to bear in mind that d i f f i c u l t y in classifying a question does not detract from i t s quality. What kind of thinking does the question demand? During a conference you w i l l be able to rephrase and pursue an answer until the level of thinking i s demonstrated by the student. -122-QUESTION SET 1 1. Was Florence Nightingale a better p o l i t i c i a n than a nurse? 2. Which statements in this report are not adequately supported? 3. Name three routes by which medications are given. A. If a patient exhibits restlessness, pallor, rise in pulse and f a l l in BP, what is one possible reason? 5. Make a plan to teach an adult diabetic how to test his own urine. 6. Describe how you would feel i f you were going to surgery tommorow. 7. Decide i f this graph is an accurate representation of the given information. 8. What is the normal white c e l l count? 9. How many milligrams of morphine would you give i f the order was for 15 grains? 10. Explain what is meant by electrolyte imbalance. 11. What have you assumed to be true i f you accept these conclusions? 12. Mrs. Smith has recently had a cholecystectomy. How w i l l this affect her diet? 13. Having worked as a team member, do you think the responsibility for ensuring a patient's adequate flu i d intake rests with the team leader more than the staff nurse, the staff nurse more than the team leader," or both equally? 14. What would be the probable consequences of allowing an uncon-scious patient to l i e on his back? -123-1. E 2. An2 3. K2 4. K3 5. S2 6. SI 7 . E Answers to Question Set 1 8. Kl 9. CI 10. C2 11. Anl 12. Ap 13. An2 14. C3 -124-QUESTION SET 2 1. If a patient in bed has f l u i d retention, where i s edema likely to be found? 2. What does "3 centimetres dilated" mean? 3. How would you plan to meet the affective needs of this teenager i f he's to be hospitalized for three months? 4. Considering economics and resources is i t better for this patient to convalesce at home or in hospital? 5. I f patients were given free access to their medical record would this increase or decrease their anxiety? 6. How does blood clot? 7. What are the advantages and disadvantages of using non-allergenic tape? 8. Describe the signs you observed that led you to your diagnosis. 9. What would health services be like i f the nursing profession was abolished? 10. What are five important rules to follow when giving medications? 11. Defend the view that counting drugs at the end of each shift i s the best way to ensure the requirements of the Drug Act are met. 12. How would you use "reflection" when talking to the mother of a newly admitted child? 13. How many bones are there in the spinal column? -125-1. C3 2. CI 3. S2 A. E 5. An2 6 . K3 7. C2 Answers to Question Set 2 8. Anl 9. SI 10. K2 11. E 12. Ap 13. Kl -126-QUESTION SET 3 1. What happens ln the lungs If the patient sits slumped in bed? 2. Select foods that would be the most suitable for this patient. 3. What range of Apgar scores i s considered normal? 4. If you were this man and you wanted to explain to your wife how you f e l t , what would you say? 5 . Draw a graph of the blood pressure recordings you made. 6. How does this child's behavior compare with the normal developmental stage of his age group? 7 . What theory explains the origin of pressure 6ores? 8 . Which vitamins are in an orange? 9. Why i s i t important to check the pupils following head injury? 10. How would you plan to teach a blind mother how to bath her baby? 11. What non-verbal cues did you identify that led you to your conclusion? 12. What is the most appropriate strategy for encouraging this patient to be more independent? 13. How big an airway would you need for a child of that size? -127-1. C3 2. E 3. K2 l*. SI 5. CI 6. An 2 7. K3 Answers to Question Set 3 8. Kl 9. C2 10. S2 11. Anl 12. E 13. Ap -128-QUESTION SET A 1. What would the patient have to do to convince you that she i s in severe pain? 2. Distinguish between excretion, secretion and elimination. 3. What factors i n these laboratory reports have significance for the nurse? A. How do you take the temperature of a two year old? 5. What are the side effects of digoxin? 6. What might happen i f a patient ate a meal on the day following abdominal surgery? 7. Name the instrument used to record blood pressure. 8. Give an example of an endocrine gland. 9. Are the available resources being effectively used for this patient? 10. Write out directions for mixing formula for this mother to take home. 11. How would you use your knowledge of normal range of motion when caring for an unconscious patient? 12. Think of a way of arranging things so this patient could feed himself. 13. What is the specificity theory of pain? -129-1. An 2 2. CI 3 . Anl A . K2 5. Kl 6. C3 7. K l Answers to Question Set A 8. C2 9. E 10. SI 11. Ap 12. S2 13. K3 -130-The following Question Classification chart summarizes Unit I. It should prove useful as you work through the remainder of this module. The chart combines and adapts the work of: Clegg, Ambrose and others. "Teacher strategies of questioning for e l i c i t i n g selected cognitive student responses." Paper presented at the American Educational Research Association Annual Meeting, February 1969. Manson, Gary and Ambrose Clegg. "Classroom questions: Keys to Children's thinking?" Peabody Journal of Education, March 1970. Hunkins, Francis. Involving Students in Questioning. Boston, Allyn and Bacon Inc., 1976. QUESTION CLASSIFICATION CATEGORY COGNITIVE ACTIVITY REQUIRED  KEY CONCEPTS SAMPLE QUESTION WORDS 1. KNOWLEDGE RECALL The question, regardless of complexity can be answered by simple r e c a l l of previously learned material. Memory Repetition Description Knowledge What; When; Who; Which; Define; Describe; Identify; L i s t ; Name; Recall; Show; State; How; Indicate; T e l l ; Yes or No questions, e.g., Did? Was? Is? 2. COMPREHENSION UNDERSTANDING Questions that can be answered by merely restating and re-organizing material l n a rather l i t e r a l manner to show that the student understands the essential meaning. Explanation Comparison Illustration Compare; Contrast; Conclude; | Demonstrate; Differentiate; Predict; LI Reorder; Which; Why; Distinguish; 1 Estimate; Explain; Extend; Extrap-olate; Rearrange; Rephrase; Inform; What; F i l l ln; Give an example of; Illustrate; Relate; T e l l i n your own words. 3. APPLICATION SOLVING Questions that involve problem solving l n new situations with minimal identification or prompting of the appropriate rules, principles, or concepts. Solution Application Apply; Build; Construct; Solve; Test; Consider; Demonstrate (ln a new situation); How would; Check out. A. ANALYSIS EXPLORATION OF REASONING Questions that require the student to break an Idea into i t s component parts for logical analysis, facts, opinions, logical conclusions, etc. Induction Deduction Logical Order Support your; What assumptions; What reasons; Does the evidence support the conclusion; What does the patient seem to believe about; What words indicate bias or emotion; What behaviors. 5. SYNTHESIS CREATING Questions that require the student to combine her ideas into a statement, plan, pro-duct, etc. that is new for her. Productive Write; Think of a way; Create; ^ Thinking Propose a plan; Put together; Suggestjp> Novelty Develop; Make up; Formulate a solution; Synthesize; Derive. 6. EVALUATION JUDGING Judgement Questions that require the Selection student to make a Judgement about something using some cri t e r i a or standard for making her judgement. Choose; Evaluate in term9 of; Decide; Judge; Select on the basis of; Which would you consider; Defend; What is the most appropriate; For what reasons do you favor; Which policy. -133-UNIT T W O -134-Unit II Major Objective: When you have completed this unit, you w i l l be able to generate questions at each level of Bloom's Taxonomy. Specifically, you w i l l : 1. Given an i l l u s t r a t i o n , generate questions at each level. 2. Given a simulated student description of her c l i n i c a l experience, generate questions at each level. 3. Given an educational objective for the c l i n i c a l experience, generate questions at each level. Resources Needed None. Estimated Time to Complete Two - three hours. Prospect of Unit II In Unit I you gained knowledge of Bloom's Taxonomy and how i t relates to questions. You then classified questions according to the cognitive level required of the student in order to answer the question. In this unit you w i l l be asked to formulate your own questions. You w i l l be presented with three diagrams, three objectives and three situations. For each set you w i l l generate questions at each level. Suggested questions as responses to each task are presented. These w i l l vary considerably from the responses you make. Therefore, you must be your own c r i t i c of whether or not each of your questions is directed to the specified cognitive level. - 1 3 5 -i LEARNING ACTIVITY FIVE Study the i l l u s t r a t i o n s . Compose questions about any idea the i l l u s t r a t i o n brings to mind; questions you might d i r e c t to your students during a post c l i n i c a l conference. Write your questions using the s i x major categories only. Ignore the subcategories from now on. Knowledge Comprehension Ap p l i c a t i o n Analysis Synthesis Evaluation -136-Questlon Set 5 Question Set 5 KNOWLEDGE COMPREHENSION A P P L I C A T I O N A N A L Y S I S S Y N T H E S I S EVALUATION -138-Question Set 5 Knowledge What Is the major cause of accidents in the aged? Comprehension Explain why ageing people are less able to handle the hazards of the environment. Application Test out your knowledge about changes in sensory status by assessing this 84 year old man. Analysis What specific data lead you to infer that he i s suffering from sensory restriction? Synthesis Suggest ways of increasing the sensory stimuli of the environment for this patient. Evaluation Judge whether extended care units are the best way of caring for our aged. -139-Recall that for purposes of this module the word question is used to include any request by a teacher calling for an in t e l l e c -tual or cognitive response on the part of the student. -140-Question Set 6 Question Set 6 KNOWLEDGE COMPREHENSION A P P L I C A T I O N A N A L Y S I S S Y N T H E S I S EVALUATION -142-What are the four basic food groups? Describe your breakfast and allocate each of the foods you ate to one of the four groups. How would you assess this patient's nutritional status? What does the patient seem to believe about the relation-ship between food and health? Flan a week's menu for this patient to take home. What would be the most appropriate policy for health professionals to adopt i n order to raise the nutritional status of Canadians? -143-By now you may be so absorbed with questions that you think we view c l i n i c a l conferences as being simi-lar to a T.V. quiz show. Recall that we said this module deals with one small aspect of the total teaching strategy required to con-duct a conference. - 1 4 4 -Q u e s t l o n Set 7 -145-Question Set 7 KNOWLEDGE COMPREHENSION APPLICATION ANALYSIS SYNTHESIS EVALUATION -146-What does In t e r s t i t i a l mean? Demonstrate how you would check i f an I.V. i s int e r s t i t i a l ? How would you apply your knowledge of asepsis when monitoring an I.V.? In this hospital, a patient with an I.V. is on Intake and Output. What might be the reasons for this policy? Think of a way of immbolizing the I.V. needle without immobolizing the patient. Decide which type of needle would be the most appropriate for a) a child? b) a short term surgical patient? c) an emaciated person? -147-LEARNING A C T I V I T Y S I X Study the following educational objectives which relate to hypothetical c l i n i c a l experiences. Formulate questions that may be asked during a post-clinical conference following a c l i n i c a l experience designed to meet these objectives. -148-Question Set 8  General Objectives 1. The student w i l l assess the patient's need for rest (sleep) and r e l i e f of pain. 2 . The student w i l l institute measures to promote rest (sleep) and relieve (reduce) pain. . Q u e s t i o n Set 8 KNOWLEDGE C O M P R E H E N S I O N A P P L I C A T I O N A N A L Y S I S SYNTHESIS E V A L U A T I O N -150-Questlon Set 8 Knowledge 1. Define pain. 2 . Describe the pain relieving drugs prescribed for this patient. Comprehension 1. Explain the difference between pain tolerance and pain threshold. 2 . Explain what i s meant by the Gate Control theory. Application How might you apply the Gate Control theory in relieving this dying man's pain? Analysis What data from the nursing history and the nurses' notes was important in your assessment of this patient? Synthesis Propose a plan whereby you involve his visitors in instituting pain r e l i e f measures. Evaluation On the basis of this man's cardiac status, which breathing exercise for relaxation would you decide to teach him? -151-Questions in this module are directed only toward fostering cognitive or intellectual s k i l l s . The emotional and psychomotor components are not being consid-ered. -152-Question Set 9 General Objective The student w i l l apply knowledge of therapeutic communication in the care of selected patients. Q u e s t i o n Set 9 KNOWLEDGE COMPREHENSION APPLICATION ANALYSIS SYNTHESIS EVALUATION -154-What principles should a nurse bear in mind when conducting an interview? Give an example of a nursing goal for an interview. How did you allow your patient to know your goal for the interview? What non-verbal behaviors did you deliberately use in order to create an atmosphere conducive to therapeutic communication. You say you didn't use good eye contact. Can you think of a way to practice so you don't feel that you are "staring"? Which of the non-verbal behaviors you have described best accomplished your goal? -155-While the emphasis of t h i s module i s on questions that you, as a nursing i n s t r u c t o r ask i n order to foster c r i t i c a l thinking, i n r e a l i t y , the student's response w i l l inform you about which cognitive l e v e l i s being used. Questions directed to-ward the higher cognitive l e v e l s r e -quire time to answer. -156-Question Set 10 General Objective The student w i l l apply principles of nursing care to the child hospitalized with commonly encountered medical conditions. Q u e s t i o n Set 10 KNOWLEDGE COMPREHENSION APPLICATION ANALYSIS SYNTHESIS EVALUATION -158-Question Set 10 Knowledge Comprehension Application What ±6 acute bronchiolitis? Why i s oxygen run through ice in a croupette? How would you ensure an adequate f l u i d intake for a nine-month old child with bronchiolitis in a croupette? Analysis Explain your reasons for recording the observations you made regarding the need for oxygen. Synthesis How do you plan to meet this child's need for sleep' Evaluation Is i t better to nurse this child in a private room or in a ward with other children? -159-LEARNING ACTIVITY SEVEN Study the simulated descriptions of a questions that may encourage c r i t i c a l student's c l i n i c a l experience. Generate thinking on the part of the student. -160-Question Set 11 Your f i r s t year student was assigned the following patient to admit and prepare for surgery the next day. The only data you had prior to the patient's arrival were: Mrs. C. 30 years old. Housewife. Married. Two children aged 2 and 4. For bilateral ligation and stripping of varicose veins. Admission orders: 1. Bathroom privileges. 2. Regular diet. 3. Prep, both legs. 4. Seconal 100 mg. h.s. The student admitted Mrs. C , recorded a nursing history and performed the surgical prep. The student charted information and performed a l l procedures satisfactorily, but you are concerned when she remarks during the conference, "I don't know what Mrs. C. is so worried about. After a l l , she's only in to have her veins stripped." Q u e s t i o n Set 11 KNOWLEDGE COMPREHENSION A P P L I C A T I O N A N A L Y S I S S Y N T H E S I S E V A L U A T I O N -162-Question Set 11 Knowledge Define anxiety. What are the physiological and psychological signs and symptoms of anxiety? Compr eh ens i on How might anxiety affect a surgical patient's post-operative course? Application What might you do to a) identify, b) relieve this patient's anxiety? Analysis What unusual events did your patient experience from the moment she set foot in the hospital? (Unusual for her.) Synthesis Describe how a mother might feel as she leaves two small children for the f i r s t time. Evaluation Which i s the most appropriate method of pre-operative teaching; individual or group? Using the c r i t e r i a of anxiety reduction, investigate, and answer this question next week. -163-Question Set 12 Your second year student i s in the fourth week of her obstetrical experience. She has been assigned to care for Joan D, 22 years old, primipara, postpartum day 3. Baby D. i s a healthy 3.5 kg. boy. During the post-clinical conference your student reports that during feed time she found Joan D. in tears and Baby D. howling l u s t i l y . Imagine the interaction between you and this student. Generate questions as they might logically flow. Note beside each question the cognitive level to which i t is addressed. Q u e s t i o n Set 12 -165-Question Set 12 1. What did you do? K 2. What are the common complications 3rd day post-parturn? K 3. Explain your reasoning as you assessed Joan. An 4 . So you diagnosed two problems; post-parturn "blues" and engorged breasts. Which of your therapeutic communication s k i l l s did you use as you talked to Joan? Ap 5. For what reasons did you consider those statements to be the most appropriate? E 6. Does Joan's reply support or refute your diagnosis? An 7. Think of a way of ensuring Joan gets some rest today. S 8. Decide i f feeding the baby in the nursery would give her rest or exacerbate her depression. E 9 . What is engorgement of the breasts? K 10. Why does this occur on the 3rd day post-partum? C 11. How did you teach Joan how to express her breasts? Ap 12. What other r e l i e f measures for breast engorgement were described in class? K 13. On what basis would you select the use of a nipple shield as the most appropriate measure? E 14. Describe the condition of Joan's breasts. K 15. How would you explain the use of a nipple shield to her? Ap 16. Look up the answers to the questions you couldn't answer. Make up an assessment check l i s t for a patient similar to Joan. S 17. How w i l l you find out tomorrow whether your interventions were effective or not? An -166-Question Set 13 Your second year student, nearlng graduation, has been working as a member of a team caring for 16 patients on a medical ward. During the shift the student assists with the emergency admission of Mrs. McKay, age 63 years, found unconscious by a neighbour. During the conference the student gives the following data. The diagnosis i s cerebral haemorrhage with right hemiparesis. On admission Mrs. McKay was conscious but unable to respond verbally. The student examined Mrs. McKay and reported: - T.37 P.80 R-22 B.P. 190/100 - noisy breathing - l e f t eyelid and cheek sag pupils equal and react to light - drooling from l e f t side of mouth - responds to questions with a grunt - normal grip in l e f t hand. Right hand limp. The admission orders were: 1. Neuro signs q.30 min. u n t i l stable 2. 0 2 by nasal cannula at 6-8 l i t r e s per minute 3. suction p.r.n. 4. Insert Foley #16 5 cc. bag and connect to straight drainage 5. I.V. 500 cc. 52 G/W q.8 h. Imagine the Interaction between you and this student. Generate questions as they might logically flow. Note beside each question the cognitive level to which i t Is addressed. -167-Q u e s t i o n Set 13 -168-Question Set 13 1. What does aphasia mean? K 2. What area of the brain is affected when aphasia is present? C 3. Does aphasia indicate impaired intellectual ability? C 4. Pretend for a moment that you cannot speak while we a l l talk to you ... Describe how you f e l t . S 5. Suggest ways of helping a patient with aphasia to communicate. S 6. How might you involve Mrs. McKay's family in helping her to communicate? S 7. As Mrs. McKay regained consciousness and realised she was in hospital, what did you do to provide support? Ap 8. What is the difference between flaccid and spastic paralysis? C 9. Why is the l e f t side of the face affected when the right side of the body is paralysed? C 10. How did .you position Mrs. McKay? Ap 11. For what reasons did you position her in that way? An 12. Make out an hour by hour plan of activities for Mrs. McKay for the next day in order to commence rehabilitation. You may wish to consult a speech therapist and a physiotherapist. S 13. For what reasons did the doctor request neuro signs? An 14. For what reasons did you use suction? An 15. What might happen i f you gave a drink to Mrs. McKay? C 16. How w i l l you meet Mrs. McKay's nutritional needs? Ap -169-Summary of Unit II In this unit you formulated questions directed to each cognitive level. Although there was no direct way for you to check your responses, the suggested responses should have served to guide you in correcting your questions. By now you w i l l realise that composing questions at the higher levels i s hard work and requires practice. -170-UNIT T H R E E -171-Unit III Major Objective When you have completed this unit you w i l l be able to evaluate questions asked during post-clinical conferences. Specifically you w i l l : 1. Analyse questions asked by you and your students during a post-clinical conference. 2. Construct a Question Profile for yourself and your students. 3. Interpret your Question Profile. Resources Needed Tape recorder Audio-tape of a post-clinical conference Pocket calculator (optional) Estimated Time to Complete One - two hours. Prospect of Unit III On page 10 of this module, you were asked to tape a post-clinical conference. In this unit you w i l l do a careful analysis of your own questions during this conference. You w i l l be required to record the questions you asked, record the questions your students asked, allocate each question to a level as you did in Unit I and construct a question profile of yourself. -172-LEARNING ACTIVITY EIGHT Record Questions Listen to the tape of your c l i n i c a l conference. On the pages indicated, write out: a) the objectives of the c l i n i c a l experience, b) the questions you asked, c) the questions your students asked. Examine each question. Decide to which cognitive level i t i s addressed and mark beside i t : K C Ap An S E You w i l l find that, in addition to questions directed toward the cognitive domain, you also asked: a) Procedural questions, e.g., What time is it? Does everyone understand? Can someone pick i t up tomorrow? etc. Mark these questions " P " . b) Questions directed toward the affective domain of the student, e.g., Did you feel confident? I guess you were upset? etc. Mark those questions "Af". -173-O b j e c t i v e s o f the C l i n i c a l E x p e r i e n c e -174-Q u e s t l o n s Asked By You -175-Q u e s t i o n s Asked By Students -176-Count the number of questions you asked excluding procedural and affective ques-tions. Count the number of questions you asked at each level. Enter your scores in the boxes on the following page. Cal-culate relative percentages. Do the same for questions asked by your students. -177-YOUR QUESTIONS NUMBER OF EACH GRAND TOTAL OF TYPE OF QUESTIONS QUESTIONS YOU ASKED KNOWLEDGE X 100 COMPREHENSION X 100 APPLICATION X 100 ANALYSIS X 100 SYNTHESIS X 100 -EVALUATION X 100 --178-STUDENT QUESTIONS NUMBER OF EACH TYPE OF QUESTIONS GRAND TOTAL OF QUESTIONS STUDENTS ASKED KNOWLEDGE X 100 COMPREHENSION X 100 APPLICATION X 100 ANALYSIS X 100 SYNTHESIS X 100 EVALUATION X 100 -179-LEARNING ACTIVITY NINE Enter your calculated percentages into the Question Profile tables for both you and your students. Answer the questions that follow. -180-Your Question Profile Question Type Percentage Knowledge Comprehension Application Analysis Synthesis Evaluation Your Students' Question Profile Question Type Percentage Knowledge Comprehension Application Analysis Synthesis Evaluation -181-Interprettng the Question Profiles Carefully consider the implications of the percentage figures and answer the following questions. 1. Note the relative percentages of questions at each level In your profile. Describe the probable effect of your questions upon the development of student thinking. 2 . To what extent were your questions directed toward the educational objectives of the c l i n i c a l experience? Of your school? 3 . Compare your percentages with those of your students. Is there a similar pattern? Do your students know how to ask questions? -182-4 . Do your questions require an instant answer or do you pose questions that need time for a reply? 5. Lis t some specific changes you would like to make i n your questions. -183-Summary of Unit III In this unit you analysed the questions that you and your students asked during a post-clinical conference that was recorded prior to your work on the module. Now that you have completed the module you may wish to tape another conference in a few weeks time and repeat Unit III. You w i l l then be able to compare your profiles and decide whether you are achieving your desired changes. It bears repeating that there are many other aspects to a post-clinical conference and that asking questions i s only one teaching behavior. This module has provided you with basic knowledge about questions. The annotated b i b l i o -graphy suggests further resources for those interested in continuing to study. -184-Annotated Bibliography Bloom, Benjamin (ed.) Taxonomy of Educational Objectives. Handbook I: Cognitive  Domain. London, Langman Group Ltd. 1956. Describes the cognitive levels in far more detail than in this module. Examples of questions are those for multiple choice exams. Carin, Arthur and Robert Sund. Developing Questioning Techniques. A Self Concept Approach. Columbus, Ohio, Charles E. M e r r i l l Publishing Co. 1971. This book is based on Bloom's Taxonomy. In addition to questions directed toward the cognitive domain, i t also considers those directed toward the affective domain. Hunkins, Francis. Questioning Strategies and Techniques. Boston, Allyn and Bacon Inc. 1972. An excellent resource for any teacher. This book considers many aspects of questioning that have not been considered in this module. Recommended for anyone wishing to pursue this topic. Matheney, Ruth. "Pre- and Post-conferences for Students." American Journal  of Nursing 69:286-289. February 1969. A very well-written article that discusses many aspects of conferences. While not analyzing questions, i t does stress their importance. This article w i l l help place questions in perspective. Quiring, Julia. " U t i l i z i n g questioning strategies in nursing education." Journal of Nursing Education, August 1973. Discusses two strategies that may be employed by nursing instructors in planning questions. Sanders, Norris. Classroom Questions. What Kinds? New York, Harper and Row 1966. A useful book for anyone interested in learning more about questioning techniques and strategies. 

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