Running Head: Critical Thinking 1C 1

Critical Thinking Paper 1C: Rubric Design

Gina Gessner

Georgetown University

Critical Thinking Paper 1C 2

Essay exams are frequently used in higher education to allow students a vehicle for

displaying relevant information in a comprehensive and ordered format (Brennan, 1995). The

questions below are designed are for students enrolled in an undergraduate medical surgical

nursing course. Course objectives include providing safe and effective care for adults in the

medical surgical population. Also, upon completion of the course students should have a broad

understanding of common medical-surgical complications and related treatment goals for this

patient population. Students should also know risk factors and common co-morbidities of

diseases and how these relate to nursing care and education of patients. Students in this course

must have a thorough grasp on pathophysiology (a prerequisite) and how it relates to the nursing

care of adults. Students in this course must also have prior knowledge in nutrition (a prerequisite)

and be able to utilize background knowledge and apply it appropriately in the clinical setting.

A grading rubric for the essay was devised for several reasons. Firstly, it is important for

students and teachers to have a clear understanding of what is required from the essay. A study

by Norton (1990) found that teachers were most concerned with structure and argument while

students focused mostly on presentation and providing an answer to the essay question. Thus, by

clearly delineating what is required from an essay, the risk for confusion is reduced. Secondly, if

used correctly, a rubric can serve as a teaching as well as an evaluative tool (Andrade, 1997). A

properly designed rubric gives students clear example of high quality work as well as poor work.

When a rubric includes a description scale for a corresponding letter grade, the student can

comprehend why the received the grade and how they can improve future performance (Moskal,

2000).

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An analytic rubric was chosen due to the fact that conceptual understanding and critical

thinking skills would be assessed. This type of rubric would also allow for the assessor to

provide detailed feedback for the students regarding their performance (Billings & Halstead,

2009). The rubric will list a criterion and exhibit varying degrees of quality to which the

students’ work will be assigned. By including a descriptive statement in the rubric, interrater

reliability is increased (Moskal, 2000). An analytic rubric also has the benefit of eliminating

overly harsh penalties when assigning a grade (Moskal, 2000). A benefit of using a rubric to

grade essays is its flexible quality. The instruction can tailor the rubric to more heavily weight

different evaluative aspects (Moskal, 2000). Additionally, “by developing a pre-defined scheme

for the evaluation process, the subjectivity involved in evaluating an essay becomes more

objective” (Moskal, 2000, p. ). Rubrics used in higher education are commonly theory based,

utilizing Benner’s novice to expert or Bloom’s cognitive domains (Gantt, 2010). The A level

work will most closely resemble the higher levels of cognitive domain in Bloom’s Taxonomy,

evaluation, synthesis and analysis. The rubric also touches on the affective domain, in regards to

valuing and respecting all persons which is particularly important in nursing

(http://www.nwlink.com/~donclark/hrd/bloom.html). Elements in the rubric regarding

grammar, APA format and the appropriate use of sources were included to help refine students’

abilities to create a professional paper. The questions for the students require the student to

utilize critical thinking skills by utilizing background knowledge of pathophysiology,

synthesizing that information with med-surg nursing and nutrition to communicate appropriately

with patients. The rubric places heavy emphasis on integration of knowledge encouraging a well

conceptualized response.

Questions

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#1. Jill Stewart is a 34yo female newly diagnosed with obstructive sleep apnea related to her

large neck circumference and BMI of 34, which classifies her as obese. Jill states, “I don’t want

to wear my CPAP machine, isn’t there anything else I can do?” You explain to Jill that her sleep

apnea could be attributed to her obesity. Jill is shocked and wants to know, “if there is anything

else obesity can cause?” Please explain how obesity can be attributed to health complications in

the medical-surgical population in multiple organ systems, including cardiovascular, respiratory,

endocrine and an additional system of your choosing. Please explain to Jill how these conditions

are managed in the clinical setting and describe appropriate nursing interventions for each.

Answer:

CV: Obesity can increase risk of heart attack, stroke. Obesity causes increase in systemic

blood flow as well as increases cardiac output. The obese individual is more at risk for

atherosclerotic vascular changes which increase risk for MI and stroke. Adipose tissue

secretes estrogen which increases risks of blood clots. Hypertension and high lipid levels can

be caused by a poor diet. Hypertension is also caused by excess weight. It is also likely that

an obese person will have high cholesterol and coronary artery disease which are linked to a

poor diet. The conditions are very serious and require a high level of medical and nursing

care. The nurse should educate the person regarding dietary changes (low salt, low fat),

weight reduction, the importance of medication compliance (antihypertensives, statins). The

nurse should also screen patients in the primary and acute care setting.

Respiratory: Excess adipose tissue can reduce the amount of lung expansion and result in

poor ventilation. Also, excessive tissue around the neck can compress upper airway

structures resulting in apnea while sleeping. The nurse should screen patients for OSA in the

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inpatient setting to reduce risk of apnea. The nurse can counsel patients on management

options regarding CPAP masks, use or weight reduction.

Endocrine: Metabolic syndrome is common in obese individuals. Adipose tissue is active

metabolic tissue that can increase insulin resistance, which results in DM II. Prolonged high

glucose levels due to diet can cause insulin resistance as well. The nurse should educate the

patients regarding dietary changes, weight reduction, medication compliance. The nurse

should educate these patients about potential complications from these conditions.

Other: Student may mention musculoskeletal issues such as hernia, osteoarthritis, in which

excess weight erodes connective tissue in knees, hips and other weight bearing joints.

Gallstones are more common in obese individuals. Certain cancers grow from increased

estrogen which is produced from adipose. Infertility is caused by obesity however this is not

necessarily a med-surg concern. Other answers may be acceptable.

2. Obesity and weight loss teaching is an important role of the nurse although some find it

difficult to discuss in the clinical setting due to sensitivity of the subject as well as it’s time

consuming nature. Please explain in detail how you would approach teaching Jill about her

weight loss.

Answer:

Explain to Jill that a decrease in overall calories consumed will result in weight reduction.

Explain to Jill that exercise is recommended to aid in weight loss as well beneficial to her

cardiovascular system. Adding more fruits, vegetables and whole grains to her diet should also

help in weight reduction as well as being beneficial to her overall health. Give the patient

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resources such as support groups, ADA information, and weight loss organizations, such as

weight watchers, etc. if she would like although this is not necessary. Consider using an

interdisciplinary approach and utilize nutritionist for additional teaching. Students should elicit

tact and professionalism in their communication with the patient.

Rubric

A to A- B to B- C to C- D and below

Student exhibits high

level critical thinking

and responses are well

conceptualized.

Responses exhibit

critical thinking.

Responses somewhat

conceptualized and

lack evidence of

critical thinking.

Responses poorly

conceptualized and

little critical thinking

is evident.

Student justifies

nursing interventions

with pathophysiology,

nutrition and med-

surg nursing

knowledge to provide

a comprehensive

response.

Nursing interventions

are somewhat justified

with pathophysiology,

nutrition and med-

surg knowledge.

Nursing interventions

are appropriate.

Student’s

interventions are

lacking in prior

knowledge of

pathophysiology,

nutrition and med-

surg nursing.

Prior knowledge in

pathophysiology and

nutrition is not

integrated in response.

Nursing interventions

are absent or not

appropriate.

Student thoroughly

addresses all aspects

of questions asked

and supports ideas.

Student addresses all

aspects of questions.

Student minimally

addresses all aspects

of questions.

Some aspects of

question remain

unanswered and

unsupported.

Student displays

evidence of holistic

and respectful

communication.

Student displays

respectful

communication.

Communication

techniques are

somewhat

compassionate and

respectful.

Evidence of

compassion and

respect for the patient

is lacking in

responses.

Thoughts well

organized in a logical

sequence.

Thoughts organized

and sequential.

Writing somewhat

disorganized and

lacks flow.

Writing is

disorganized and

difficult to follow.

APA format 6th

edition was used

correctly. Spelling

and grammar are

correct.

APA format 6th

edition was used with

few errors found. Few

spelling and

grammatical errors.

APA format 6th

edition was used with

some errors found.

Some spelling and

grammatical errors.

APA format 6th

edition was used very

poorly or not at all.

Many spelling and

grammatical errors.

Appropriate use of

sources provides

support for statements

made.

Sources are used, but

may not be

appropriate to support

statements.

Sources are minimally

used or not used

appropriately.

Sources are lacking or

not used appropriately

to support ideas.

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References

Andrade, H. G. (1997) Understanding Rubrics. Educational Leadership, 54(4), 14-17.

Billings, D. M. & Halstead, J. A. (2009). Teaching in nursing: A guide for faculty. Saunders

Elsvier: St. Louis.

Brennan, M. J. (1995) Essay writing in nursing: alerting students and teachers to the educational

benefits. Nurse Education Today, 15 (5), 351-356.

Clark, D. R. (1999) Learning Domains of Bloom's Taxonomy. Retrieved from

http://www.nwlink.com/~donclark/hrd/bloom.html: what

Gantt, L. T. (2010). Using the Clark Simulation evaluation rubric with associate degree and

baccalaureate nursing students. Nursing education perspectives, 31 (2), 101- 105.

Moskal, B. M. (2000) Scoring rubrics: What, When and How? Practical assessment, research

and evaluation, 7 (3).

Norton L. S. (1990) Essay-writing: what really counts? Journal of Higher Education, 20, 411-

442.sayn L S 1

Andre

G990 Essay-w

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