Marie Tarrant

The frequency of item writing flaws in multiple-choice questions used in high stakes nursing assessments

Multiple-choice questions are a common assessment method in nursing examinations. Few nurse educators, however, have formal preparation in constructing multiple-choice questions. Consequently, questions used in baccalaureate nursing assessments often contain item-writing flaws, or violations to accepted item-writing guidelines. In one nursing department, 2770 MCQs were collected from tests and examinations administered over a five-year period from 2001 to 2005. Questions were evaluated for 19 frequently occurring item-writing flaws, for cognitive level, for question source, and for the distribution of correct answers. Results show that almost half (46.2%) of the questions contained violations of item-writing guidelines and over 90% were written at low cognitive levels. Only a small proportion of questions were teacher generated (14.1%), while 36.2% were taken from testbanks and almost half (49.4%) had no source identified. MCQs written at a lower cognitive level were significantly more likely to contain item-writing flaws. While there was no relationship between the source of the question and item-writing flaws, teachergenerated questions were more likely to be written at higher cognitive levels (p<0.001). Correct answers were evenly distributed across all four options and no bias was noted in the placement of correct options. Further training in item-writing is recommended for all faculty members who are responsible for developing tests. Pre-test review and quality assessment is also recommended to reduce the occurrence of item-writing flaws and to improve the quality of test questions.

Impact of item-writing flaws in multiple-choice questions on student achievement in high-stakes nursing assessments.

Context  Multiple‐choice questions (MCQs) are frequently used to assess students in health science disciplines. However, few educators have formal instruction in writing MCQs and MCQ items often have item‐writing flaws. The purpose of this study was to examine the impact of item‐writing flaws on student achievement in high‐stakes assessments in a nursing programme in an English‐language university in Hong Kong.

Breastfeeding and weaning practices among Hong Kong mothers: a prospective study

BackgroundBreastfeeding provides optimal and complete nutrition for newborn babies. Although new mothers in Hong Kong are increasingly choosing to breastfeed their babies, rates of exclusive breastfeeding are low and duration remains short. The purpose of this study was to describe the breastfeeding and weaning practices of Hong Kong mothers over the infants first year of life to determine the factors associated with early cessation.MethodsA cohort of 1417 mother-infant pairs was recruited from the obstetric units of four public hospitals in Hong Kong in the immediate post-partum period and followed prospectively for 12 months or until weaned. We used descriptive statistics to describe breastfeeding and weaning practices and multiple logistic regression to investigate the relationship between maternal characteristics and breastfeeding cessation.ResultsAt 1 month, 3 months, 6 months and 12 months only 63%, 37.3%, 26.9%, and 12.5% of the infants respectively, were still receiving any breast milk; approximately one-half of breastfeeding mothers were exclusively breastfeeding. Younger mothers, those with a longer duration of residence in Hong Kong, and those returning to work postpartum were more likely to wean before 1 month. Mothers with higher education, previous breastfeeding experience, who were breastfed themselves and those who were planning to exclusively breastfeed and whose husbands preferred breastfeeding were more likely to continue breastfeeding beyond 1 month. The introduction of infant formula before 1 month and returning to work postpartum were predictive of weaning before 3 months.ConclusionsBreastfeeding promotion programs have been successful in achieving high rates of breastfeeding initiation but the focus must now shift to helping new mothers exclusively breastfeed and sustain breastfeeding for longer.

An assessment of functioning and non-functioning distractors in multiple-choice questions: A descriptive analysis

BackgroundFour- or five-option multiple choice questions (MCQs) are the standard in health-science disciplines, both on certification-level examinations and on in-house developed tests. Previous research has shown, however, that few MCQs have three or four functioning distractors. The purpose of this study was to investigate non-functioning distractors in teacher-developed tests in one nursing program in an English-language university in Hong Kong.MethodsUsing item-analysis data, we assessed the proportion of non-functioning distractors on a sample of seven test papers administered to undergraduate nursing students. A total of 514 items were reviewed, including 2056 options (1542 distractors and 514 correct responses). Non-functioning options were defined as ones that were chosen by fewer than 5% of examinees and those with a positive option discrimination statistic.ResultsThe proportion of items containing 0, 1, 2, and 3 functioning distractors was 12.3%, 34.8%, 39.1%, and 13.8% respectively. Overall, items contained an average of 1.54 (SD = 0.88) functioning distractors. Only 52.2% (n = 805) of all distractors were functioning effectively and 10.2% (n = 158) had a choice frequency of 0. Items with more functioning distractors were more difficult and more discriminating.ConclusionThe low frequency of items with three functioning distractors in the four-option items in this study suggests that teachers have difficulty developing plausible distractors for most MCQs. Test items should consist of as many options as is feasible given the item content and the number of plausible distractors; in most cases this would be three. Item analysis results can be used to identify and remove non-functioning distractors from MCQs that have been used in previous tests.

Breast-feeding and childhood hospitalizations for infections.

Background: Infectious disease is a leading cause of morbidity and hospitalization for infants and children. During infancy, breast-feeding protects against infectious diseases, particularly respiratory infections, gastrointestinal infections, and otitis media. Little is known about the longer-term impact of breast-feeding on infectious disease in children. Methods: We investigated the relationship between infant feeding and childhood hospitalizations from respiratory and gastrointestinal infections in a population-based birth cohort of 8327 children born in 1997 and followed for 8 years. The main outcomes were public hospital admissions for respiratory infections, gastrointestinal infections, and all infectious diseases. Cox regression was used to assess time to first hospitalization. Results: Breast-feeding only (no formula-feeding) for 3 or more months was associated with a lower risk of hospital admission in the first 6 months of life for respiratory infections (hazard ratio = 0.64 [95% confidence interval = 0.42–0.97]), gastrointestinal infections (0.51 [0.25–1.05]), and any infection (0.61 [0.44–0.85]), adjusted for sex, type of hospital at birth, and household income. Partial breast-feeding (both breast-feeding and formula-feeding) in the first 3 months also reduced hospitalizations from infections but with smaller effect sizes. Beyond 6 months of age, there was no association between breast-feeding status at 3 months and hospitalization for infectious disease. Conclusions: Giving breast milk and no formula for at least 3 months substantially reduced hospital admissions for many infectious diseases in the first 6 months of life, when children are most vulnerable.

Predictors and Consequences of In-hospital Formula Supplementation for Healthy Breastfeeding Newborns

Background: Although exclusive breastfeeding is recommended for the first 6 months, the use of breast milk substitutes is widespread around the world. Objectives: To describe the patterns of infant formula supplementation among healthy breastfeeding newborns, to identify factors contributing to in-hospital formula supplementation, and to assess the dose-response relationship between the amount of in-hospital formula supplementation and the duration of any breastfeeding. Methods: A sample of 1246 breastfeeding mother–infant pairs was recruited from 4 public hospitals in Hong Kong and followed prospectively for 12 months or until weaned. Multiple logistic regression analysis was used to examine factors associated with in-hospital supplementation. Cox regression analysis was used to explore the impact of in-hospital supplementation on breastfeeding duration. Results: Of the total, 82.5% of newborns were supplemented in the hospital; one-half received formula within 5 hours of birth. Assisted vaginal delivery (odds ratio [OR] = 2.06, 95% confidence interval [CI] 1.03, 4.15), cesarean section (OR = 3.45, 95% CI 1.75, 6.80), and higher birth weight (OR = 1.56, 95% CI 1.12, 2.18) were positively associated with in-hospital formula supplementation, whereas initiating breastfeeding in the delivery room (OR = 0.55, 95% CI 0.33, 0.89) was associated with decreased likelihood of in-hospital supplementation. Any infant formula in the first 48 hours was associated with a shorter duration of breastfeeding (hazard ratio [HR] = 1.51, 95% CI 1.27, 1.80), but there was no dose-response effect. Conclusion: In-hospital formula supplementation is common in Hong Kong hospitals and appears to be detrimental to breastfeeding duration. Continued efforts should be made to avoid the provision of infant formula to breastfeeding babies while in the hospital unless medically indicated.

Prevalence and predictors of maternal seasonal influenza vaccination in Hong Kong

BACKGROUND Pregnant women infected with influenza virus are more likely to experience severe complications when compared with their non-pregnant peers. Yet influenza vaccine uptake is low among pregnant women. The purpose of this study was to assess the prevalence of seasonal influenza vaccine uptake among pregnant women in Hong Kong and to identify predictors of vaccine uptake. METHODS Using a multi-center cross-sectional design, we recruited 2822 new mothers during their immediate postpartum stay from all eight public obstetric hospitals in Hong Kong. We assessed antenatal maternal influenza vaccination status as well as health beliefs and perceptions toward influenza and influenza vaccination. Bivariable and multivariable logistic regression was used to identify the predictors of vaccination uptake. RESULTS Only 49 (1.7%; 95% CI 1.3-2.3%) participants were vaccinated during their pregnancy. Fear that the vaccine would cause harm to the fetus or themselves were the most common reasons for not being vaccinated. Being aware of the vaccination recommendations (OR=2.69; 95% CI 1.06-6.82), being advised by a health-care provider (OR=6.30; 95% CI 3.19-12.46), history of vaccination (OR=2.47; 95% CI 1.25-4.91), perceived susceptibility to influenza infection (OR=3.67; 95% CI 1.64-8.22), and perceived benefits of influenza vaccination (OR=9.98; 95% CI 3.79-26.24) were all independently associated with vaccination. Perceived barriers to vaccination (OR=0.17; 95% CI 0.07-0.40) were strongly associated with failure to vaccinate. CONCLUSIONS Low seasonal influenza vaccination uptake among Hong Kong pregnant women was related to a number of factors, all of which are amenable to interventions. Vaccination promotion strategies need to focus on encouraging health-care providers to discuss vaccination with their pregnant clients and in providing pregnant women with accurate and unbiased information about the risks of influenza infection and the benefits of vaccination.

Association between intrapartum interventions and breastfeeding duration.

INTRODUCTION Few women who reside in Hong Kong exclusively breastfeed, and one-half stop breastfeeding within the first few months. There is little research in this population on the association between intrapartum interventions and breastfeeding duration. METHODS A sample of 1280 mother-infant pairs were recruited from the obstetric units of 4 public hospitals in Hong Kong and followed prospectively for 12 months or until the infant was weaned. The outcome variables for this analysis were the duration of any and exclusive breastfeeding. Predictor variables were 4 intrapartum interventions: receipt of opioid pain medication, induction versus spontaneous labor, epidural administration, and mode of birth. We used Cox proportional hazards modeling to assess the impact of intrapartum interventions on the duration of any and exclusive breastfeeding, and we constructed Kaplan-Meier survival curves to evaluate the cumulative impact of multiple intrapartum interventions on breastfeeding outcomes. RESULTS Bivariate analysis showed that induction of labor (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.09-1.41), opioid pain medication (HR, 1.21; 95% CI, 1.06-1.37), and having an emergency cesarean birth (HR, 1.22; 95% CI, 1.01-1.48) were associated with a shorter duration of any breastfeeding. Induction of labor (HR, 1.23; 95% CI, 1.08-1.39) and having an emergency cesarean birth (HR, 1.25; 95% CI, 1.05-1.51) were associated with a shorter duration of exclusive breastfeeding. After controlling for known confounding variables, there was no longer any association between individual intrapartum interventions and the duration of any or exclusive breastfeeding. The median duration of breastfeeding for participants who experienced a natural birth with no intrapartum interventions was 9 weeks compared with 5 weeks for participants who experienced at least 3 intrapartum interventions. DISCUSSION Clinicians working with new breastfeeding mothers should focus on providing additional support to mothers who experience a difficult labor and birth with multiple interventions to improve their breastfeeding experiences.

Development of the Family Nursing Practice Scale

This article describes the development and testing of the Family Nursing Practice Scale (FNPS). This self-report questionnaire is designed to measure perceived changes in family nursing practice including attitudes toward working with families, critical appraisal of their family nursing practice and reciprocity in the nurse-family relationship. Categories were derived from a needs assessment, competence as effective application of knowledge and skill and theoretical foundations for family assessment and intervention. Psychometric testing (content, construct validity, internal consistency, and test-retest reliability) was undertaken with 140 psychiatric nurses in Hong Kong. Practice appraisal and nurse-family relationships accounted for 56.4% of the variance. Cronbach’s alpha reliability coefficients were .88 and .73 for the two subscales, respectively, and .86 for the scale overall. Test-retest reliability ranged from .62 to .93 on the individual items. The results provide preliminary evidence of the reliability and validity of the FNPS. The instrument provides quantitative and qualitative evaluation components.

Professional breastfeeding support for first-time mothers: a multicentre cluster randomised controlled trial.

To evaluate the effect of two postnatal professional support interventions on the duration of any and exclusive breastfeeding.