In the Art of War, Sun Tzu stated:
“If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.”
Although The Art of War was written in the 5th century BC this quote is still as pertinent today as it was then.
For nursing students you enemy is the NCLEX®.
It is the one thing standing between you and RN. So rather than complain about the test and how hard it is ect . . . Let’s present another possible solution:
Learn everything you can about HOW the NCLEX is written
The NCLEX® is based on a set method for writing questions known as “Bloom’s Taxonomy for the Cognitive Domain“.
In fact in the NCLEX®-RN test plan the NCSBN states:
“Bloom’s taxonomy . . . is used as a basis for writing and coding items for the examination”
Wow! . . . so if the Bloom’s Toxonomy is the foundation of NCLEX® questions it seems pretty important to understand exactly what it is.
What is Bloom’s Taxonomy?
Essentially it is nothing more than a method for classifying learning objectives and organizing them into levels of intellectual behavior and cognitive ability.
Originally it was developed to provide a congruent framework for teachers to write test questions and to serve as a groundwork in developing learning goals for students.
It is important to understand that each successive level in the taxonomy builds upon the previous (ie it is impossible to create if you do not understand). In other words from remember to create, the learner is required to call upon a higher level of cognitive ability.
Now that we have a good understanding of critical thinking from the previous lesson, let’s dive in a bit to Bloom’s Taxonomy and try to marry how the two are related when it comes to critical thinking and test taking in nursing school.
This classification was originally developed in 1956 but was revised in 2001 to include the following categories from simple to complex (Anderson & Krathwohl, 2001).
The NCSBN further states that:
“Since the practice of nursing requires application of knowledge, skills and abilities, the majority of items are written at the application or higher levels of cognitive ability, which requires more complex thought processing.”
It’s for this reason the rumor goes around that if you have a lot of SATA (select all that apply) questions on your test then you must be doing well as these are considered to be at the evaluate level.
It is also for this reason that nursing educators repeat the catch phrase “critical thinking” . . . over, and over, and over . . . . and over.
Remembering is Not Enough
Remembering simple anatomy facts or information is just not enough. This won’t help you on tests and it won’t help you take care of patients.
As your critical thinking skills and knowledge base improve you should notice that the questions you are taking are becoming more complex and more priority focused.
You should be moving beyond ‘What is the normal sodium level?’ to ‘What treatment would you provide for a patient experiencing urine output of 6L for the last 24 hours?’
Notice how the second question requires you to make a connection between a symptom and diabetes insipidus which would further make you think of sodium levels and urine specific gravity and methods for slowing urine output and improving the sodium level?
Can you see the difference?
This is analysis and evaluation level of Bloom’s Taxonomy.
As you are initially learning facts it is important to learn that information but you have to go beyond.
The single most important thing you can do as a nursing student and nurse is to always ask . . . .WHY?
The nurse that fails to ask why is frankly a scary nurse.
Asking why means that you never accept a fact or piece of information as is. It essentially means critical thinking . . . you are gathering information until the dots connect.
If a professor states that: Steroids cause osteoporosis.
You immediately raise your hand and ask: why?
Facts mean nothing if you are unable to connect the dots, understand the underlying reason, and make the entire picture makes sense.
The first requirement for any instructor at NRSNG is that they find methods for making the dots connect and for explaining the WHY.
If they are not able to do this, then it is pointless to teach the material. Students are capable of reading and memorizing facts on their own. Our job as instructors is to facilitate your progression from remembering to analysis and evaluation.
You job is to dig and dig and dig until you get to the root of the issue. I remember learning the RAA system the first time. I annoyed my wife to death because I would stay up late into the night for about a week straight with about 10 books in the bed trying to make sense of it. Until I was able to connect it all and understand the process forwards and backwards, I kept digging!
If one book or video leaves you with questions, your job is to move to another resource until you have drawn lines between all your questions and you can explain the entire process. When you’ve reached that level, you are at the analysis level.
Alright, when we talk about Bloom’s Taxonomy, there’s a really good chance that maybe you’ve never even heard of Bloom’s Taxonomy and that’s completely okay. But I want to explain it to you because this is going to give you an advantage over all of your classmates, over all of the other nurses, and nursing students taking the NCLEX, taking exams. Not only that this is also going to give you kind of a leg up when we start talking about critical thinking, because this is gonna help you begin to structure the way that you learn and the way that you take test. So, in the Art of War written by San Tzu, he had a quote, alright. And the quote was, “If you know the enemy, and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory game, you will also suffer defeat. If you know neither the enemy nor yourself, you will succumb to every bottle.” Now, know the art of war was written in the 5th century BC, this quote is still pertinent today. And what we’re gonna learn here in this lecture about Bloom’s Taxonomy is we’re gonna learn about our enemy. Okay, we’re gonna learn about the NCLEX and here’s that quote again and I want you to really focus on that. “If you know the enemy and know yourself, you need not fear the result of a hundred battles.” So, if you understand nursing school test, if you understand how they are structured, if you understand why they are structured the way they are, you have no reason to fear the outcome of any test. Now, that comes down to a lot of things. And that’s what this whole NRSNG academy is built around, is giving you the knowledge, so that you don’t have to worry about those tests, part of that is learning the content that’s in the other courses, in MedSurg course, the OB course, the Peds course, all the other content courses. In here, we’re going to learn about the strategies and the tactics and specifically in this course, in this module, in this lesson right now, about Bloom’s Taxonomy, we’re gonna learn specifically how the NCLEX is written.
So, for nursing students, your enemy is the NCLEX. It is the one thing standing between you and RN. It doesn’t matter how successful you were or not in school. It doesn’t matter how much you think, you know. It doesn’t matter how skilled you are. It doesn’t matter how many IVs you’ve started. The only thing stopping you from having that RN is a successful score on the NCLEX. So, rather than complain about the test and how hard it is, and how annoying it is, and how frustrating it is and all that stuff, let’s present another possible solution. Learn everything you can about how the NCLEX is written.
So, we’re going to focus, as I’ve said for several times, on the Bloom’s Taxonomy. Now, the NCSBN, the company that administers, writes the NCLEX, the National Council of State Boards of Nursing who administers the NCLEX and administers your license. The Bloom’s Taxonomy, they said, is used as a basis for writing and coding items for the examination. Okay, it’s called the Bloom’s Taxonomy for cognitive domain and they’ve listed it as that important. So, the Bloom’s Taxonomy is the foundation of NCLEX questions. It seems pretty important to understand exactly what it is. So, let me tell you a little question or a little riddle here. Who’s got two thumbs and determines your future as an RN? Boom! This guy, Dr. Benjamin Bloom. Benjamin Bloom is the one who developed Bloom’s Taxonomy in the 50’s and 60’s an it’s that structure that he developed, that the NCSBN now uses as a basis for writing and quoting items for the NCLEX examination.
So, what is, let’s dive into it a little bit more. Essentially, it’s nothing more than a method for classifying learning objectives and organizing them into levels of intellectual behavior and cognitive ability. Originally, it was developed to write a congruent framework for teachers to write test questions and service a ground work for developing and learning goals for students. But it’s grown from there and become the framework for developing NCLEX questions.
Now, let’s look at it. This little pyramid here is essentially what the NCLEX or what Blooms taxonomy is. It’s important to understand that each successive level in the Taxonomy builds upon the previous. For example, if you look up here, it’s impossible to create something out of information if you do not understand it, okay. In other words, from remember to create, the learners require to call upon a higher level of cognitive ability. So, in order to understand something, you have to first remember it. And once we understand it, we can then apply that knowledge, okay? We can take that knowledge and apply it. Then, once we’ve applied that knowledge, okay, once we’ve used it, maybe on the clinical floor, we begin to analyze it, evaluate and then create from there. So now we get to understand critical thinking from previous lessons, let’s dive in a bit to Blooms Taxonomy and try to merry how the two are related when it comes to critical thinking and test taking in nursing school. So, this classification was originally developed by 1956 but revised again in 2001 to include the following categories from simple to complex. Remember, understand, apply, analyze, evaluate, and create. So, this is making a little bit of sense to you and we’ll talk about a little bit more.
But, let’s do another quote from the NCSBN. Further, they state that “Since the practice of nursing requires application of knowledge, skills and abilities, the majority of items are written at the application or higher levels of cognitive ability, which requires more complex thought processing.” So, for this reason, the rumor goes around that if you have a lot of set of questions or selected all the applied questions on your test, then, you must be doing well. As generally, this set of all these applied questions, are considered to be at the evaluate level. It’s also the reason that nursing educators are put to cat’s race critical thinking over and over and over again, okay. So, the NCLEX has just told us that the majority of NCLEX questions are written at this application level, okay? So, the reader written an application or analysis, evaluation and creation. So, there’s not a lot of NCLEX question about Remember.
Let’s throw out what a Remember question would be. So, first of all, remembering is not enough. Okay, you can’t just remember facts and information and do well on the nursing school exams, on the NCLEX, or as a nurse. Trust me, you can’t just remember simple facts. Remembering simple anatomy facts is not enough, it’s just simply, it’s not enough. This won’t help you on test and it won’t help you take care of your patients. As your critical thinking skills and knowledge base improve, you should notice that the questions you are taking are becoming more complex and more priority focused. You should be moving beyond questions like “What is the normal sodium level?” to questions like “What treatment would you provide or would you expect for a patient experiencing urine output of 6 liters for the last 24 hours?” So, both of them require you to understand sodium levels, right? That first question is talking about just basic normal sodium levels. Do you remember this fact that normal sodium is 135 to 145? It’s a super easy fact, you’ve learned it, in MedSurg, you learned it, in Anatomy, now did you remember it? Okay, that’s too easy. Okay, that’s not how it’s going to work. You’re not gonna walk into the patient’s room, and your assessment is gonna be, “Hey, what’s your sodium level?” No, your assessment is gonna be looking at their Foley bag and seem like Holy cow, they’ve done 6 liters of urine in the last 24 hours. I need to check the sodium level. I need to see that this patient is in Diabetes Insipidus. I need to make sure what our neuro status is but you’re also looking at your sodium level. You know, you’re expecting your sodium level, changes in your sodium level based on the patient urinating 6-liter. You’re expecting sodium level to be 165, you know, but they both have to do with what’s sodium is, what we would experience, what we’d expect out of sodium levels. But one is simply asking and remember question, the other is asking you o dig deeper. Okay, so, that’s really what we have to do here. Can you see this difference? Can you see this analysis and evaluation level of the Blooms Taxonomy? Now, this is very different than anything that you’ve experienced before, in exams, in questions, in tests, before nursing school, you were taking, in anatomy, for example, do you remember, o what is this bone? What is this bone? You know, you walk into your anatomy lab, they have, you know, 200 bones labeled and you have to identify each of them. Or, you have to remember where the kidney is or the function of the kidney. That’s simply not enough to understand at a nursing level. To understand at analysis level, you have to have that information in your brain, you have to have learned it, you have to have remembered it, now, you can start analyzing and going beyond, okay. So, you really have to go beyond. As you’re initially learning facts, it’s important to learn that information but you have to go beyond. So, you have to learn, you have to memorize, you have to remember, but then, you have to go on.
Now, how do you go on? You have to do one simple thing. The single most important thing that you can do as a nursing student and as a nurse is to ask why. The nurse that fails to ask why is frankly a very scary nurse. Asking why means that you never accept a fact or a piece of information as is or as simply given to you. But, it essentially means critically thinking or gathering information until all the dots connect. If a professor states “Steroids cause osteoporosis.” You immediately shoot your hand up in the air and say Why? Or, how?” Facts mean nothing if you’re unable to connect dots understand the underlying reason and make the entire picture makes sense to you. Now, at NRSNG, the very first requirement we have for every instructor here, is that they find methods and they’re capable of explaining things and the way that make dots connect and explaining the ‘Why?’ That’s what we’re interested in. We’re interested in those linchpins, that’s what we talk about when we’re talking these linchpins, these pieces of information that make the ‘Why’ make sense. If a professor is unable to do this and it’s pointless to teach material. Students are capable of reading and memorizing facts on their own. That’s easy to do. You can open a book, read, make flashcards, memorize, boom. But our job as instructors, and your job as a student, but more so, our job as instructors is to facilitate your progression from remembering, to analysis, and evaluation.
So, what you can do is you can keep digging. Your job is to dig and dig and dig until you get to the root of the issue. I remember the first time I was learning the R-A-A System. Remember, when I was trying to learn it in nursing school, right, ‘cause in Anatomy and Physiology, I had learned about Renin-Angiotensin-Aldosterone. I learned the basics of it. You know, but in nursing school, I was trying to get that analysis level that I could walk into the room or I could see a disease process, I could see labs and I could make connections between the R-A-A System, what pharmacology would be needed, what assessment things I was going to find that you don’t learn in Anatomy and Physiology, okay. So, I remember when I was trying to get to this analysis level with the R-A-A system, it was truly giving me a very hard time. Now, I probably annoyed my wife to death because I would stay up late into the night for about a week straight with probably 10 books in bed trying to make sense of all this. And until I was able to connect all the dots and understand the entire process, the R-A-A system, forwards and backwards, I kept digging every night writing out notes, drawing pictures, drawing diagrams, doing it again, jumping from one book to the next, watching videos on youtube, and everything. If one book doesn’t make sense, or one video leaves you with questions, your job is to move to another resources and tell you a drawn lines between all of your questions and you can explain the entire process. When you’ve reached that level, you’re at the analysis level. That’s where you drive. That’s where you have to be. Now, our goal, as I’ve said before at NRSNG, is to get you to that level. Hopefully, in your classes, you got to remember them. Okay, you’ve learned it, you’ve remembered it.
Now, let’s get to this Analysis level. Okay, I’d never wanted you to accept stuff of face value. That’s what we talked about in critical thinking as well. Never accept facts, okay. Gather all information, alright? Learn everything that you can about something and tell you can truly analyze it. If all you know about sodium is about 135-145, you are going to struggle greatly. When you’re learning disease processes, you have to learn it at a deeper level. You can’t just be memorizing, you have to start connecting these dots and analyzing information. The whole body is a system, you have to learn this whole system, how everything interconnects, and how everything works. So, I want you to be aware of this, okay. As we’re going through, now, we can’t explain everything in here and make everything work. That’s what the rest of the NRSNG academy is about, is getting all that, okay? What you need to take from this, is what Blooms Taxonomy is, and the level of understanding that you have to get to. But, now, that you understand this, okay, now that you understand what Blooms Taxonomy is, how deeply you need to understand information, I want this to stay at the forefront of your mind as you continue to study. And as you do that, your understanding is going to grow, your willingness to ask why, your willingness to ask questions and to dig will grow stronger and you will become a strong nurse, you’ll become a strong student, and you’ll be somebody that people can rely on. Not just other nurses, not just other health care providers, but your patients can rely on. That’s the ultimate goal. So, dig, dig, dig until you get to this analysis level.