HESI Exams: An Overview of Reliability and Validity

HESI specialty exams were developed to assess students' knowledge and their ability to apply nursing concepts within specific content areas. Faculties often use scores provided by these specialty exams as a substitute for teacher-made final exams. The E2 was developed to assess students' preparedness for the licensing exam. Data provided by these exams can be useful in preparing self studies for accreditation that are required by accrediting agencies. The National League for Nursing Accrediting Commission (NLNAC)[2] and the Commission on Collegiate Nursing Education (CCNE)[3] require schools of nursing to demonstrate a systematic program evaluation. HESI Summary Reports provide content area scores that can be used to evaluate curricular strengths and weaknesses.[4] Because these exams provide interval-level data, the data can be analyzed using a variety of statistical methods. Since the E2 has demonstrated a high degree of accuracy in predicting outcomes of NCLEX-RN and NCLEX-PN,[4,5,6,7] nursing faculties are increasingly choosing to use E2 scores as benchmarks for progression and remediation.[8,9]

The conceptual framework used to develop HESI exams is grounded in classical test theory and critical thinking theory. The creation, administration, and interpretation of tests are accomplished through educational and psychological measurement processes. Crocker and Algina[10] stated that measurement of psychological attributes occurs when quantitative values are assigned to the trial of behaviors obtained from administering a test. By observing and classifying similar behaviors, the test designer is able to draw inferences about the psychological constructs that contribute to the makeup of the test taker. The test designer may also be able to identify relationships between psychological constructs and practical consequences, therefore predicting test-taking behaviors, such as success in academic programs or nursing practice. To make such predictions, the test designer must first quantify the observations representing the constructs that define these behaviors. The nurses who design and revise the nursing exams use course syllabi from nursing programs across the United States in combination with NCLEX test blueprints provided by the National Council of State Boards of Nursing (NCSBN)[11,12] to define the constructs indicative of behaviors required for entry-level practice. HESI item writers create test items for use on HESI exams that specifically measure these behaviors. Figure 1 describes the theoretical framework for development of HESI exams.

HESI conceptual framework for test development.

The method used by HESI for development of critical thinking test items[13,14] is based on concepts derived from the critical thinking theory described by Paul[15] and the cognitive taxonomy developed by Bloom.[16] Test items on all HESI exams are written and reviewed by nurse educators and clinicians who evaluate the merit of the items as current measures of nursing practice-specifically, the items that reflect high-priority and high-frequency activities characteristic of entry-level RN practice. All submitted test items are reviewed by HESI nurse educators and modified, as needed, by HESI editors. Each test item is categorized by numerous subject areas, and each subject area provides subset scores. All test items are stored in a database along with their particular item analysis data.

HESI specialty exams are available for RN curricula only. However, PN specialty exams are currently in the pilot stage. The specialty exams presented in this article describe only the eight most widely used RN specialty exams.

Specialty exams are designed to measure the student's ability to apply concepts related to specific clinical nursing content areas. Typically, specialty exams consist of 50 test items. Test blueprints for these exams are developed by HESI nurse educators whose clinical practice area is congruent with the exam being developed. Test items that measure nursing knowledge and competencies within the specific clinical specialty area are selected from the HESI database.

Custom exams are specialty exams that are designed to meet specific curricular evaluation needs. Typically, custom specialty exams consist of 50 test items. Test blueprints for custom exams are developed by HESI nurse educators and include the content domain specified in the syllabus or syllabi that are provided to HESI by the faculty requesting the development of a custom exam. Test items that best measure nursing knowledge and competencies within the designated content area are selected from the HESI database. Custom exams are completed following consultation between faculty and HESI nurse educators to ensure that the final products are valid for the constructs to be tested.

Midcurricular exams are custom exams that evaluate content from several nursing courses. Typically, midcurricular exams consist of 100 test items. These exams are administered halfway through the curriculum, which makes them useful as exit exams at the conclusion of the first half of the curriculum. While it is impractical to cite reliability findings for every custom exam that has been developed, the reliability of custom exams is determined in the same manner as it is for all other HESI exams.

The E2 is a 150-item comprehensive exam that is designed for administration near the completion of the curriculum to measure student preparedness for the NCLEX-RN or NCLEX-PN. It is used to identify the strengths and weaknesses of the students and the possible need for remediation prior to taking the licensure exam. Four versions of the E2 are available for RN students, and two versions are available for PN students. RN students serve as the norming group for the test items that are included on the RN version of the E2, whereas PN students serve as the norming group for the PN version of the E2. Different versions of the E2 are often used to retest those students who require remediation so that the success of such remediation can be evaluated.

The HESI Predictability Model, a proprietary mathematical model, is used to calculate scores for HESI specialty exams and HESI exit exams. All scores provided by these HESI exams are based on the application of this model to the raw data. Test items are individually weighted based on their difficulty level, which is determined by dividing the number of correct responses to the item by the total number of responses to that item, thereby deriving a percentage of correct responses to the item. Each HESI specialty exam and HESI exit exam also provides a conversion score. This score is presented as a percentage that reflects the average weight of all the test items on an exam and the average weight of the test items answered correctly. Therefore, this conversion score is a weighted percentage score that faculty can include as a part of the student's final course grade.

Crocker and Algina[10] identified the basic elements of an exam within the framework of classical test theory as the observed score, the true (universe) score, and the error score (error of measurement). The relationship provided by these scores is described by the formula: observed score equals true score plus error score. Crocker and Algina[10] and Sax[17] asserted that the reduction of systematic and random error is critically important to ensure that obtained scores on tests closely represent the student's true score. All item analysis and reliability calculations regarding HESI exams are based upon this interpretation.

The item analysis data include each test item's difficulty level and discrimination data as expressed by the point biserial correlation coefficient as well as the number of times the test item has been used on an exam. These data are stored for the last administration of the test item as well as for all administrations of the test item (cumulative data). No test item is scored on any HESI exam until it has been piloted and the item analysis data obtained on that item. HESI nurse educators review and revise test items based on the results of pilot testing. The parameters HESI uses to judge the quality of test items include a cumulative difficulty level of no less than 40% and a point biserial correlation coefficient of 0.15 or above. HESI exams that contain 50 test items include five pilot (nonscored) items, and exams that contain 75 or more test items include 10 pilot items.

Position guide: Scrum-half

The scrum-half's basic role is to deliver the ball from the base of the scrum, ruck or maul to spark the backline, but that is too simplistic and ignores hundreds of other key characteristics.

The traditional skills of passing and kicking are obviously important and you need a broad range of those skills.

A scrum-half needs to be able to deliver the ball not just from the base but however it comes at him, whether that is over the head or through the legs.

And kicking is not just all about the traditional box kick. It's little grubbers along the floor, or long punts or quick tap penalties.

Other elements such as defence, organising how the forwards links with the backs, man-management, decision-making, staying on your feet and minimising your time at the bottom of rucks also make up the scrum-half armoury.

But one of the most important attributes of a good scrum-half is a natural instinct and confidence, though sadly these are quite often coached out of players in favour of the basics.

I don't mean you have to be a fantastic public speaker or have that first-on-the-dancefloor confidence. It's about being confident in your understanding of how the team are trying to play and being able to implement those ideas as an individual.

If a scrum-half just shovels the ball out time and again, he isn't a threat and as soon as he's not a threat, the focus of the opposition back row and inside backs goes on the fly-half.

Good scrum-halves like Scotland's Mike Blair and Chris Cusiter and Wales' Dwayne Peel have all the traditional skills but you can't take your eyes off them for a moment because if you do, they're through the gap and gone and they've got the pace to finish.

Having that threat creates more room for their own backline because the opposition back row have to check for a split-second to see what they might have up their sleeves.

But you have to understand when to make breaks and when to pass and that comes from instinct and experience.

Pete Berg's Americana Is Becoming Something Else