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Check this out!

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Great tool for creating your portfolio!

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Giving Personal Feedback

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Audio Tool

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Mind mapping is a highly effective way of getting information in and out of your brain. Mind mapping is a creative and logical means of note-taking and note-making that literally "maps out" your ideas.

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Getting Started with MindMeister: Create Your First Mind Map

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8 Steps to Creating Your Video with Powtoon

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Check it Out!

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Signs and Symptoms of a Myocardial Infarction (MI)

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Signs and Symptoms of a Myocardial Infarction (MI)

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THINGLINK Example -User Friendly

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Signs and Symptoms of an M.I. by Joanne Serembus

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TOUCH this image to discover its story. Image tagging powered by ThingLink

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Metacognition -Thinking About One's Teaching

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Metacognition -Thinking About One's Teaching

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This is a rapid-fire exercise where students shout out 5-10 concept-related terms that the instructor lists on a whiteboard. Then, as you work through and discuss each term, the instructor erases them one by one, enhancing students’ recall capabilities.

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It's ok - click on the blue "watch on Vimeo" button

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How to Study Effectively for School or College | Top 6 Science-Based Study Skills - The ANSWER Method

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How to Study Effectively for School or College | Top 6 Science-Based Study Skills - The ANSWER Method

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How to Study Effectively for School or College [Top 6 Science-Based Study Skills]

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Dr. Margaret Dow, M.D., Assistant Professor of Obstetrics and Gynecology, Mayo Clinic College of Medicine discusses a quick and easy method of approaching clinical teaching - The One Minute Preceptor model.

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List of Computer Games for Teaching Students

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List of Computer Games for Teaching Students

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7 Online Tools to Make Custom Learning Games (No Coding Required!)

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By Elizabeth Kahn It is a fact that even in the 21st century, students need to study and review information they’ve been taught in class. In fact, many scientific studies have asserted that learning doesn’t take place without repetition. Study guides created by the teacher or student in the form of…

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Teaching Critical Thinking Using Case Studies

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Teaching Critical Thinking Using Case Studies

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Summary

This paper examines the use of case studies as teaching strategies to promote critical thinking. Critical thinking and case studies are defined as teaching method. The benefits and limitations of case studies are also discussed. The literature review investigates research studies that have indicated how case studies facilitate and promote active learning, help clinical problem solving, and encourage the development of critical thinking skills. Using case studies in teaching will assist nurse educators in promoting active learning; furthermore, it will help in developing critical thinking skills, which are extremely important for nurses and other health care professionals.

View full text

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Promotion of critical thinking by using case studies as teaching method

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This paper examines the use of case studies as teaching strategies to promote critical thinking. Critical thinking and case studies are defined as teaching method. The benefits and limitations of case studies are also discussed. The literature review investigates research studies that have indicated how case studies facilitate and promote active learning, help clinical problem solving, and encourage the development of critical thinking skills.

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Instructions

Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the patient does, not what the clinician thinks the patient can do. The clinician should record answers while administering the exam and work quickly. Except where indicated, the patient should not be coached (i.e., repeated requests to patient to make a special effort).
**SPECIAL NOTE: The instructions below refer to attachments such as a picture, naming sheet, list of sentences, and words. Those items are not attached, but can be accessed by opening the PDF version of the NIH Stroke Scale (pdf, 495 kb) ) on this site and viewing pages 5-8.** Scale Definition
Instructions
Level of Consciousness:

The investigator must choose a response if a full evaluation is prevented by such obstacles as an endotracheal tube, language barrier, orotracheal trauma/bandages. A 3 is scored only if the patient makes no movement (other than reflexive posturing) in response to noxious stimulation.
Scale Definition
0 = Alert; keenly responsive.
1 = Not alert; but arousable by minor stimulation to obey, answer, or respond.
2 = Not alert; requires repeated stimulation to attend, or is obtunded and requires strong or painful stimulation to make movements (not stereotyped).
3 = Responds only with reflex motor or autonomic effects, or totally unresponsive, flaccid, and areflexic.

LOC Questions:
The patient is asked the month and his/her age. The answer must be correct - there is no partial credit for being close. Aphasic and stuporous patients who do not comprehend the questions will score 2. Patients unable to speak because of endotracheal intubation, orotracheal trauma, severe dysarthria from any cause, language barrier, or any other problem not secondary to aphasia are given a 1. It is important that only the initial answer be graded and that the examiner not "help" the patient with verbal or non-verbal cues.
Scale Definition
0 = Answers both questions correctly. Answers one question correctly. Answers neither question correctly.

LOC Questions:
The patient is asked to open and close the eyes and then to grip and release the non-paretic hand. Substitute another one-step command if the hands cannot be used. Credit is given if an unequivocal attempt is made but not completed due to weakness. If the patient does not respond to command, the task should be demonstrated to him or her (pantomime), and the result scored (i.e., follows none, one, or two commands). Patients with trauma, amputation, or other physical impediments should be given suitable one-step commands. Only the first attempt is scored.
Scale Definition
0 = Performs both tasks correctly.
1 = Performs one task correctly.
2 = Performs neither task correctly.
Scale Definition
Best Gaze:
Only horizontal eye movements will be tested. Voluntary or reflexive (oculocephalic) eye movements will be scored, but caloric testing is not done. If the patient has a conjugate deviation of the eyes that can be overcome by voluntary or reflexive activity, the score will be 1. If a patient has an isolated peripheral nerve paresis (CN III, IV, or VI), score a 1. Gaze is testable in all aphasic patients. Patients with ocular trauma, bandages, pre-existing blindness, or other disorder of visual acuity or fields should be tested with reflexive movements, and a choice made by the investigator. Establishing eye contact and then moving about the patient from side to side will occasionally clarify the presence of a partial gaze palsy.
Scale Definition
0 = Normal. = Partial gaze palsy; gaze is abnormal in one or both eyes, but forced deviation or total gaze paresis is not present.
2 = Forced deviation, or total gaze paresis is not overcome by the oculocephalic maneuver.
Scale Definition
0 = No visual loss.
1 = Partial hemianopia.
2 = Complete hemianopia.
3 = Bilateral hemianopia (blind including cortical blindness).
Scale Definition
0 = Normal symmetrical movements.
1 = Minor paralysis (flattened nasolabial fold, asymmetry on smiling).
2 = Partial paralysis (total or near-total paralysis of lower face).
3 = Complete paralysis of one or both sides (absence of facial movement in the upper and lower face).
Scale Definition
0 = No drift; limb holds 90 (or 45) degrees for full 10 seconds.
1 = Drift; limb holds 90 (or 45) degrees, but drifts down before full 10 seconds; does not hit bed or other support. = Some effort against gravity; limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity. = No effort against gravity; limb falls. No movement. = Amputation or joint fusion, explain:
Scale Definition
0 = No drift; leg holds 30-degree position for full 5 seconds. = Drift; leg falls by the end of the 5- second period but does not hit the bed. Some effort against gravity; leg falls to bed by 5 seconds but has some effort against gravity. = No effort against gravity; leg falls to bed immediately.
4 = No movement. = Amputation or joint fusion, explain:
Scale Definition
0 = Absent. = Present in one limb. Present in two limbs. Amputation or joint fusion, explain:

0 = Normal; no sensory loss. = Mild-to-moderate sensory loss; patient feels pinprick is less sharp or is dull on the affected side; or there is a loss of superficial pain with pinprick, but patient is aware of being touched. = Severe or total sensory loss; patient is not aware of being touched in the face, arm, and leg.
Scale Definition
0 = No aphasia; normal. Mild-to-moderate aphasia; some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression. Reduction of speech and/or comprehension, however, makes conversation about provided materials difficult or impossible. For example, in conversation about provided materials, examiner can identify picture or naming card content from patient's response.
2 = Severe aphasia; all communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener. Range of information that can be exchanged is limited; listener carries burden of communication. Examiner cannot identify materials provided from patient response. Mute, global aphasia; no usable speech or auditory comprehension.
Scale Definition
Instructions
Dysarthria:
If patient is thought to be normal, an adequate sample of speech must be obtained by asking patient to read or repeat words from the NIH Stroke Scale document pages 6 and 8 ( pdf, 495kb). If the patient has severe aphasia, the clarity of articulation of spontaneous speech can be rated. Only if the patient is intubated or has other physical barriers to producing speech, the examiner should record the score as untestable (UN) and clearly write the explanation for this choice. Do not tell the patient why he/she is being tested.

0 = Normal. = Mild-to-moderate dysarthria; patient slurs at least some words and, at worst, can be understood with some difficulty. = Severe dysarthria; patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric. UN = Intubated or other physical barrier, explain:

0 = No abnormality. Visual, tactile, auditory, spatial, or personal inattention, or extinction to bilateral simultaneous stimulation in one of the sensory modalities. Profound hemi-inattention or extinction to more than one modality; does not recognize own hand or orients to only one side of space.

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Administer stroke scale items in the order listed. Record performance in each category after each subscale exam. Do not go back and change scores. Follow directions provided for each exam technique. Scores should reflect what the patient does, not what the clinician thinks the patient can do.

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FAST

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Creating a Rubric

Rubrics are a tool to help you evaluate student performance. Knowing how to create and use rubrics gives you a better understanding of assessment and another option for assessing student performance. Rubrics are a great way to improve communication, learning, and grading fairness. In this course we will cover:

what rubrics are and how they can benefit you and your students

assessment concepts that relate to rubrics

how to create a rubric

how to judge the quality of the rubrics you create

The tutorial also provides several examples of rubrics and a list of resources where you can learn more.

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Rubrics are a tool to help you evaluate student performance. Knowing how to create and use rubrics gives you a better understanding of assessment and another option for assessing student performance. Rubrics are a great way to improve communication, learning, and grading fairness. Course authored and designed by Lisa O'Reilly, Instructional Designer."

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Woot! WOOT!

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Kahoot! | Learning games | Make learning awesome!

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Kahoot! is a game-based learning platform that brings engagement and fun to 1+ billion players every year at school, at work, and at home.

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The basics of getting started include: creating your first poll question, presenting the live results, and customizing the look and feel of your poll. You can also publish the results via email or a website.

Poll Everywhere offers several types of activities you can use to interact with the audience:

Multiple-choice polls: The audience chooses from the response options you provide (for example a choice of either true or false.) You can also upload images to serve as response options. Multiple choice polls accept both text message responses and web responses.

Open-ended questions: The audience responds freely, with anything they wish. Open-ended responses can be displayed three ways: a ticker, text wall, or cluster. You can use Moderation to manage responses before they are shown publicly. This activity allows both text message responses and web responses.

Q&A: The audience submits ideas or questions. Then they can anonymously upvote or downvote all other responses, so the best rise to the top quickly. This activity only allows web responses.

Rank order: Participants rank the response options you provide. The results display as a bar chart ranking the options 1st, 2nd, 3rd... This activity only allows web responses.

Clickable images: The audience clicks anywhere on an image to respond. You can even specify regions to count clicks in specific areas. This activity only allows web responses.

A Poll Everywhere activity is a single question or prompt you pose to your audience.

Step 1. To create an activity, tap the Create button at the top left of your Activities page.

Step 2. Select the activity you would like to create for the audience.

Step 3. Enter your question or prompt.

Multiple choice poll: Now that you have a question, enter the response options you want the audience to select from. You can use images as response options by pasting a direct link, or uploading one from your computer using picture icon. To add a response option click the plus icon. You can delete a response option by clicking the trash icon on the far right.

You can designate the correct response to a multiple choice question. Check the box to the left of the correct response option(s). A correct response will be highlighted green, when you reveal correctness on the poll chart.

Word cloud, Q&A, or open-ended questions: Simply enter the question or prompt.

Rank order: Just like multiple choice, you can enter text or add images as answer options.

Clickable image: Select one of the provided images, or upload an image you would like the audience to interact with.

If you like, you can define rectangular regions on your image where clicks will be counted. To the right of your image you can name and manage the regions, similar to the way you manage response options for multiple choice polls. This includes the ability to mark correct region(s).

Survey: Give your survey a title, and add a series of activities. Surveys allow you to ask your participants multiple questions at once. Everyone can answer the questions privately at their own pace. Surveys are great for quizzes, pre- and post-training assessments, and questionnaires.
Helpful tip: Surveys and groups can be edited after the creation process, so don't fret if it's not perfect right away.
Step 4. When you are ready, click the create button to build your activity and save it to your account.

That's it! Continue to add as many activities as you like.

When you are ready for the audience to respond, you will need to activate the poll. This publishes the poll on your PollEv.com response page (i.e. PollEv.com/your-username). To activate your poll from the Activities page, click on the Activate icon, located to the right of the poll.

To activate your poll from the poll chart click the activation button, or simply put your poll in full screen mode. The poll is automatically activated when in fullscreen mode. Only one poll can be activated on your presenter page at a time, so the only poll visible to your participants is the poll you are displaying in fullscreen mode. The next poll will automatically activate as you advance through your polling slides, dynamically adjusting your presenter page. You can always access the Activate icon by hovering over the upper right side while in fullscreen mode.

Surveys are how you present multiple questions back-to-back. Some presenters use them to create tests or to collect feedback after their presentation. Surveys are asynchronous, meaning audience members complete them at their own pace. This is especially useful for collecting responses across several hours or days.

Step 1. To create a new survey, go to Activities and click Create in the top left corner. In the resulting activity creator, select Survey. Use the Choose an activity box to select different activity types to add to your survey. When you're satisfied with your questions, hit the Create button in the bottom right.

Step 2. Now you can preview your survey and choose the way people respond to it. The blue box in the center (under Audience Devices) shows you how your survey will look on participants' phones and other devices. If you select Presentation View you can activate your survey, enter fullscreen view, and more. You can use the menu on the right to change how people respond to your survey. Note: Any changes you make here affect all activities within your survey.

Step 3. There are two ways to collect responses to a survey: live or remotely. To collect responses live, activate your survey and have the audience respond by visiting your PollEv.com/your-username response page. Additional details on how to activate an activity are located directly above this section. To collect responses remotely, send participants a share link. This link lets participants respond to a survey over several days. The survey does not need to be active for the link to work, so you can present other activities in the meantime.

To find your survey's share link, select Present followed by Share on the survey editing screen. Alternatively, you can hover over the title of your survey on Activities, and a Share option will appear.

Keep in mind that surveys only accept web responses, and that SMS text messaging is not available for surveys. If wifi for participants is unstable or unavailable at your venue, you will need to present activities individually rather than as a survey.

There are several ways an audience can respond to polls:

SMS text message responses

Web responses via the presenter's custom PollEv.com polling page

Web responses via private link

The presenter can decide which ways the audience is able to respond to polls. To do this, open the poll you would like to change. Select "How people can respond" on the right side of the poll to expand the menu. Check all of the ways you would like the audience to be able to respond.

There are two response modes you can use to allow the audience to text responses to polls: Presenter Session or Keywords.

Presenter Session allows your audience to use short responses like ABC, 123, and True/False. The audience must first text your username to the number shown on the poll to join your presenter session. After they've joined your session, they can simply text in their responses (e.g. True, A, or Yes) to all the remaining polls in your session, for up to 24 hours.

After your participants have joined your session, they can respond to an open-ended question by simply texting. There is no need to enter a long code with each response.

In most cases that involve a live presentation, Presenter Session is the way to go. It is available to all users on all plans, including the free plan.

The alternate method is Keywords mode. Keywords mode allows audience members to enter a unique auto-generated code for each response. This 6-7 digit code will be displayed on the poll. Keywords are special, because they do not require the poll to be active for your participants to submit a response.

You can also choose to use a reserved keyword, like HOUSE, instead of a code, if this feature is included in your plan. Note: While Keywords mode is available on all plans, reserved keywords are only allowed for premium paid plans. Please see our Plans and Pricing Page to see which plans include reserved keywords.

Keywords mode is better for polling that may not be conducted live. Each response option has a unique code that can be texted, without having to follow along with the presenter.

Presenter Session and Keywords modes only apply if your audience will be responding via text; web response options will be unaffected.

You do not have to commit to Presenter Session or Keywords for your entire presentation, or entire groups of polls. You can decide, poll by poll, which mode to use. Here is how to set it up:

1. Log into your Poll Everywhere account and go to your Activities page. This is the page that lists all of your polls.

2. Click on the title of the poll to open to the live chart

3. To the right of your poll, look at "How people can respond." If you want people to respond by text message (SMS) then select the appropriate checkbox

4. Once this has been selected, you will have the option to choose Presenter Session or Keywords.

Before participants can begin to respond, they must first join your presenter session by texting in your unique username custom PollEv page to the number listed on your poll. Audience members do this just once at the beginning of your session. For example, if your custom PollEv page is PollEv.com/johnsmith, your audience will need to text johnsmith to the number shown on your poll (usually 22333 in the US). They will receive a text message informing them that they have joined John Smith's session.

After the audience joins your presenter session, they will text the letter corresponding to their response (A, B, C, etc.) to the same number as before. You can choose whether the options are labeled ABC, 123, or True-False by clicking the drop-down menu under Presenter Session, in the "How people can respond" panel. On certain plans, you can also customize the ABC labels with custom keywords, such as 'Blue' to vote for blue.

In order for responses to count, you must have activated the poll. You control which poll is accepting responses, by controlling which poll is activated. If you have not activated a poll, your audience will not be able to respond.

Participants who have joined a presenter's session will stay logged in to that session until texting "leave" or after 24 hours of inactivity

If you wish to substitute a reserved keyword for the auto-generated response codes, you may need to upgrade your plan. Keep in mind that all reserved keywords come from the same globally shared word bank. This means you may only reserve keywords that are not currently in use. You can usually resolve this issue by adding a number or letter, such as HOUSE1 instead of HOUSE.

You can assign reserved keywords to your poll response options while in the Edit menu of each poll. This menu can be accessed by clicking a poll's Edit link on your Activities page or by opening a poll and selecting Edit on the bottom right side of the poll. You can also click the 'Customize code' link under the Keywords option on the 'How people can respond' panel.

In the response code column, you can type in the custom keyword you would like to reserve for each option. The system will tell you if the keyword is available.

If you are not able to type in a keyword, it means you are on a plan that does include reserved keywords and will need to upgrade to use this feature.

Premium keywords are special reserved keywords with three characters or less. They make responding even simpler, and therefore are in high demand. Premium keywords can be reserved for $5 each, subject to availability, with a minimum of $25 per order. Email our sales team for more information.

The easiest, most elegant way to respond to a Poll Everywhere poll or a survey is on your PollEv.com/your-username page. The audience visits your presenter page from a browser on any web-enabled device, and responds to the polls as you activate them. Because it works with any browser, this response option is recommended for international audiences who may not have appropriate texting and long distance plans.

On certain paid plans, you can customize your PollEv.com page from the Settings page. Your username must be alphanumeric and between 4-15 characters. To access your Settings page, click on your current username and then click the link for Settings.

In the box after 'PollEv.com/' type in the word you would like to use as your response page. This word will also be your username. Many presenters choose usernames that are concise and relevant to their presentation. If it is available, it will be your username and response page for as long as you have an account, or until you choose to change it.

For example, if John Smith were setting up his own PollEv.com response page, he would type 'johnsmith' in the box after PollEv.com/, and his audience would respond to his polls by visiting PollEv.com/johnsmith.

When you activate a poll, your PollEv.com page automatically updates to show the poll that you activated.

If the presenter is using keywords the audience can still respond PollEv.com. Once there, they type in the keywords or codes that are displayed on the poll instructions. This works for multiple choice polls and open-ended polls.

Q&A polls, Ranking Polls, Clickable image polls, and Surveys all require the presenter's PollEv/you-username response page.

Members of the audience can respond using SMS text messages from any cell phone. Standard text messaging rates apply, which means that some participants may have to pay their carriers for text messages (e.g., if they do not have unlimited SMS text messaging plans).

Multiple choice poll: The participants send a text message to the number displayed on the poll instructions (22333 in this case). In Keywords mode, the text message should contain the code or keyword associated with the answer they choose. In Presenter Session mode, the text should contain first the presenter's session name (username), and then a short ABC/123 response for each subsequent poll.

Open-ended poll: The participant sends a text message to the number displayed on the poll instructions (22333 in this case.) If you use Keywords mode, the text message should contain the code or keyword that corresponds to that individual poll, followed by their message. If you use Presenter Session mode, the first text message should contain your username, followed by their message. Responses to subsequent open-ended polls need only contain the response message, in Presenter Session mode.

The audience can SMS text their responses to polls, even if they are not based in the United States. We provide a list of countries where we believe the SMS text option will work, and a list of our various international phone numbers. On the page, there is also a way to test for yourself whether responding by SMS text works in your country.

Clickable image polls, Q&A polls, and Ranking polls do not accept text responses. The presenter must have a PollEv.com response page to use these poll types.

You can test drive your poll from the audience's perspective with the handy, built-in testing tool. When your poll is open, the menu at the top right contains a Test tab. Click that tab to experience the way audience members will join your session and/or respond.

Step 1. Choose a response mode from the How people can respond menu. You can try Presenter Session or Keywords mode.

Step 2. Open the Test tab at the top of the menu. For Presenter Session, you can try joining the session and casting an A, B, C response. For Keywords mode, you can try texting in an auto-generated code as a response. You can try web responses or text responses by switching between the two tabs at the top of the test panel.

Web response testing: Text response testing:

The testing tool will tell you if your poll is not activated. Open the poll in full screen or click the activate icon to activate the poll.

To stop accepting responses you can deactivate or lock your poll. If you lock a poll while it is still activated, participants can see the poll on your PollEv.com presenter page, but are unable to respond. To remove the poll from your PollEv.com presenter page, simply click the Activate icon once more to deactivate.

If the poll is in fullscreen mode, you can access Lock and Activate/Deactivate icons by hovering over the upper right side of the poll. Remember a poll in full screen is automatically activated.

If your poll is locked, you can easily unlock it. Just go to your Activities page, select the poll you want to unlock, and click the Unlock button at the top of the window.

If the poll is in fullscreen mode, you can find the button to lock or unlock by hovering over the upper right side of your poll until the menu becomes visible. Then click the Lock icon.

Poll is activated

Poll is deactivated

Poll Unlocked

Audience can respond + Poll appears on PollEv presenter page

Audience can respond + Poll does not appear on PollEv presenter page

Poll Locked

Audience cannot respond + Poll appears on PollEv presenter page

Audience cannot respond + Poll does not appear on PollEv presenter page

The presenter can clear a poll's results so that no responses are shown on screen. This allows you to reuse polls and save past results as an archived run. It's a good idea for presenters to send in a few test responses, but remember to clear test responses before the actual presentation.

When a poll is cleared the results are not lost or deleted. Results are stored as archived runs that can be accessed with the reporting features on a paid plan. There are several ways to clear poll results:

From the poll: Simply click the Clear responses icon. This allows you to clear responses for only that poll.

From your Activities page: Check off the boxes to the left of the titles of the polls or groups you wish to clear, and then click the Clear responses button. This allows you to clear responses from several polls at once.

You can find the archived results of a poll in the Response History view. Open this by clicking Export in the bottom right panel on your poll, then clicking Response History.

Note: The computer from which the poll is displayed must be connected to the internet.

There are two steps to presenting your poll: first, you show the instructions, so your audience knows how to respond. Second, you display the live results.

The majority of poll types have separate instructions view and results view. This allows you to show the instructions, and then wait to reveal the results when you're ready. You can toggle instructions view and results view using the eye icon on your poll. You can always access these tools by hovering over the upper right side while in fullscreen mode.

Alternatively, you can display instructions directly on the live results chart. Many presenters find that showing the results live, as they come in, in real time, increases the excitement.

You can also create your own slide of instructions, or email instructions to your participants before the event begins. We have some example graphics available in our best practices for presenters guide. This is helpful if your audience includes people from multiple countries, and you need to instruct them on how to text in their responses. (Note that for international audiences responding by the web is typically preferable.)

Your poll - both the instructions view and the results - can be presented live from the web or directly in your presentation.

The quickest and easiest way to display a poll is directly from our website in fullscreen mode. Fullscreen mode hides all other browsers and browser buttons, so that only the poll displays on your screen.

Step 1. To display a poll in fullscreen mode, select a poll from the Activities page by clicking on the poll's title.

Step 2. Select the fullscreen icon at the bottom that indicates entering fullscreen mode.

Step 3. To end fullscreen mode, hover your mouse over the poll's upper right corner and select the Exit Fullscreen icon. You can also just press the escape key on your keyboard.

To switch between different polls in the same group, you can use the arrow keys in the lower right hand corner of the screen, or the right and left arrows keys on your keyboard.

Note: The computer from which the poll is displayed must be connected to the internet.

You can display a poll directly from PowerPoint by embedding your poll as a slide, to seamlessly present with your other PowerPoint slides.

To embed your polls in PowerPoint, you must install the PollEv Presenter app. In addition, the computer displaying the presentation must be connected to the internet in order for the polls to be displayed.

The Poll Everywhere add-in is compatible with Windows 7 SP1 or later (32-bit or 64-bit) or newer, with PowerPoint 2007 with Service Pack 3 and newer.

Step 1. Download the PollEv Presenter App

Step 2. Install the app.

Step 3. Open or restart PowerPoint, and locate the Poll Everywhere ribbon at the top.

Step 4. Log into your Poll Everywhere account via the Poll Everywhere ribbon in PowerPoint.

Step 5. Using the ribbon, create a new poll for your presentation.

Step 6. Using the ribbon, insert any polls you have created into your presentation.

Step 7. Start presenting. (You must be in slideshow mode to see the polls.)

You can move poll slides to different points in your presentation by copying and pasting the entire poll slide thumbnail to the correct spot in your outline, or by simply dragging and dropping the slide.

Some systems may not allow access to downloaded plug-ins. If you are using Powerpoint 2007, you must install Microsoft Office Suite Service Pack 3. Please contact us if you have any trouble.

PollEv Presenter is currently compatible with Microsoft PowerPoint 2011 or higher for Mac and Keynote 6.5 or higher. We require Apple OS X 10.12 (Sierra) or newer.

Step 1. Download PollEv Presenter App for Mac

Step 2. Install PollEv Presenter Add-in for Mac by dragging the file to your Applications folder.

Step 3. Open PollEv Presenter Add-in from your applications folder. It should appear on your Dock when running

Step 4. In the Poll Everywhere Add-in, enter your login information.

Step 5. Insert your polls directly into your open PowerPoint or Keynote. Or create a new poll using the add-in

Step 6. Start Slide Show mode to see your polls load directly in your presentation.

Make sure the PollEv Presenter application is installed and running before presenting. The application can only display the polls when you are in Slide Show mode, and the app is running. This will be shown by the Poll Everywhere icon in your dock along the bottom of your screenand on your taskbar at the top. Click on it to run the app.

Poll slides can be created or inserted into an existing presentation. You can also download a group of poll slides and build a PowerPoint presentation around them. Poll slide thumbnails can be dragged between slides or into other presentations, just like any normal PowerPoint or Keynote slide. Resizing the grey placeholder image will indicate where a poll should load on screen.

Poll slides will appear with a screenshot of the poll as a placeholder image. This screenshot does not automatically update and may not reflect the most recent changes to your poll. The live poll will only load and display when they are in Slide Show mode. The poll will not display or receive responses until you have successfully installed and logged into the PollEv Presenter Add-in, and the slide is in full screen, or presentation mode. Whichever poll question is displayed in Slide Show mode will be automatically activated and receive results as long as you are logged into th PollEv Presenter Add-in.

Please email us at contact us if you have any trouble.

Google Slides users can reap the benefits of integrated, live polling with the PollEv Presenter Google Slides Extension.

Step 1. Navigate to PollEv Presenter for Google Slides in the Chrome Web Store and add the extension to Chrome.

Step 2. Open a new Google Slides presentation.

Step 3. Click on the Poll Everywhere tab at the top right.

Step 4. Select login from the Poll Everywhere menu.

Step 5. Log in or sign up for a new account.

Step 6. Select the polls you want to insert and click "Insert polls" or create a new poll by clicking "Create poll".

Step 7. Present your Google Slides deck to see your polls load directly in your presentation.

Make sure the Chrome Extension is installed on the computer you will use to present. The polls can only display within a Chrome web browser that has the PollEv Presenter Google Slides Extension installed and enabled. This will be shown by the Poll Everywhere icon in the address bar on any Google Slides page.

The extension can only display and activate your polls when

1. You are in Presentation mode.

2. You are logged in within the PollEv Presenter Google Slides Extension.

Poll slides can be created or inserted into an existing presentation. You can also download a group of poll slides and build a Google Slides presentation around them.

Poll slide thumbnails can be dragged between slides or into other Google Slides presentations, just like any normal slide. Moving the placeholder image will not move the poll. You must move the entire poll slide into place.

Poll slides will appear with a screenshot of the poll as a placeholder image. This screenshot does not automatically update and may not reflect the most recent changes to your poll. The live poll will only load and display when they are in Slide Show mode. The poll will not display or receive responses until you have successfully installed and logged into the PollEv Presenter Google Slides Extension, and the slide is in full screen, or Presentation mode. Whichever poll question is displayed in Slide Show mode will be automatically activated and receive results as long as you are logged into the extension.

Note that you cannot open a pre-made PowerPoint or Keynote file that has poll slides in it within Google Slides, using our extension. You must insert poll slides using the PollEv Google Slides Extension, instead.

Please contact us if you have any trouble.

The Presentation Remote is available in the mobile app store or in any mobile browser at pollev.com. With this app you can connect and control your Windows Powerpoint presentations from a mobile device. This will allow you to navigate through your presentation, control the tools of the poll visualization, and even allow you to moderate responses to open ended poll questions on certain paid plans.

Step 1. Follow the instructions for PowerPoint for Windows

Step 2. Select the remote option from the mobile app.

Step 3. Start your presentation in PowerPoint.

Step 4. Press connect.

Remember to login in with the same account on PowerPoint and on the mobile app.

The way your poll looks is entirely up to you. You can customize the look and feel of your poll through the Visual Settings menu, which is accessible when viewing any of your polls.

From this menu, you can change the font, the font size, and the colors of your poll to match your personal style, the company aesthetic, or a presentation template. You can also add an image or your logo to the title or the background of your poll.

Step 1. To change the look and feel of a poll, select the poll from the Activities page by clicking on the poll's title.

Step 2. Once the poll is loaded, select the Visual Settings icon, which appears at the top of the list.

Step 3. You can change the look and feel of your poll by adjusting different settings within the various tabs under Visual Settings: :

Here, you can control the look of the poll title, the instructions for how your audience can respond, the color or image on the poll background and much more. This panel also lets you set a logo image, choose colors and themes, and change the font.You can adjust your Instructions View or set a Heat Map, which automatically adjusts the color of the bars according to the number of responses. You can decide the chart layout, the color of the bars, and how the data appears, by either number of responses or percentages.

Step 4. To close the Visual Settings menu, click on the "x" in the upper right corner. The changes you made will be automatically saved to your poll.

You can set a default style for your polls in the Settings menu, found on the top right of any page. All new polls will have the same visual settings (e.g., colors, fonts) as the poll you select as your template poll. You can also choose to update all existing polls to match the template poll.

This is useful when you want to create multiple polls with the same look and feel without having to make each change individually.

Step 1. To set a template poll, go to your Activities page and click on your username to access the Settings button.

Step 2. Under the heading Poll Settings, click Set, and select the poll you would like to use as the template.

Step 3. You can click the "Apply to all my polls" button to retoractively set your template, and/or click the "Save" button at the bottom, to save your settings for all the polls your create moving forward.

In addition to presenting your poll live in front of an audience, you can also choose to publish your poll to a website, Facebook or any other place where people can follow a link.

Be aware that if you would like to accept responses to your poll, you will need to unlock the poll. If you would like to accept web responses from your PollEv.com page, you will also need to activate the poll, so your audience can see it when they visit your page. Learn more about accepting responses to your poll.

Each poll has a unique URL that can be shared. You can copy this URL directly from your internet browser's address box to send the poll chart to your audience. Just be sure that the poll is unlocked.

Alternately, you can visit the Present menu that appears on the right side of the poll when you are viewing the live chart. Expand the menu and click Share, then choose either the Sharable Response Link, which allows people to respond to your poll without seeing results, or the Live Results Link, which allows people to respond and see results live. For example, on a single question quiz you would use the Sharable Response Link to prevent participants from being influenced by others' responses, but for a public brainstorm or word cloud you could use the Live Results Link.

People who follow the Live Results Link will see whichever view your poll is set to at the time, either (a) the instructions view where they are instructed on how to respond or (b) the results view where they can see the current results. If you have the results hidden on your live chart, participants who follow the Live Results Link will not be able to see the results until you click the icon to show the chart.

To automatically Tweet your poll question, click the Twitter icon to the right of the sharable link you wish to Tweet.

To embed your poll in your blog or webpage, visit the Present menu that appears on the right side of the poll when you are viewing the live chart. Expand the Share menu and click on the link labeled Embed poll.

Anyone who has the unique URL can view your poll. (They will only be able to respond, however, if your poll is unlocked.) You can email a link to your poll without leaving your poll settings page. Expand the Present menu to the right of your poll, and click the Email icon, to the right of the sharable link you wish to use. If you wish, you can edit the subject line and message of the email before sending.

You can poll international participants - whether they are sitting together in one location or dispersed around the globe. There are several ways in which your international audience can participate:

Web responses on the presenter's custom polling page

International SMS text message responses

The Poll Everywhere App from the app store, available for iPhone & Android

The easiest, most elegant way for your international audience to respond to a Poll Everywhere poll is on your PollEv.com/your-username response page. It works anywhere in the world as long as the participant has access to a functioning web browser on their smartphone, tablet, laptop, or desktop. Read more about custom Pollev.com response pages.

Each audience member's ability to respond via SMS text message depends on several factors: their particular carrier, their particular text messaging plan, and the coverage we provide through our international SMS service partners.

To the best of our knowledge, here is a list of countries by continent that we believe we fully cover:

Asia, Africa, & the Middle East: China, Hong Kong, Indonesia, India, Israel, Japan, Korea (South), Malaysia, Singapore, Taiwan, Thailand, Saudi Arabia, South Africa, UAE, Qatar.

Australia: Australia and New Zealand

Central and South America: Belize, Brazil, Chile. We are currently seeking local resellers to help us serve these markets better.

Europe: Austria, Belgium, Estonia, Finland, France, Germany, Ireland, Lithuania, Norway, Poland, Spain, Sweden, Switzerland, and the United Kingdom all have local numbers. We also have regional numbers for Czech Republic, Greece, Hungary, Italy, Netherlands, Portugal, Turkey

North America: United States, Canada (Served by short codes, not the long numbers shown below) and Mexico

We offer many different phone numbers to accommodate responsding by SMS. You can share as many numbers as are appropriate to your audience. (For example, if you have audience members from several different countries, you may want to share several different phone numbers.) Additionally, some carriers don't allow texting to short codes, such as "22333", and those participants might get a response message in error. In that case, participants can text to the US 10- digit number and their response will still be accepted. The responses will all appear in your poll results no matter which number they were submitted through.

Our poll instructions will only be able to show one number at a time due to space constraints, but you can display multiple numbers on a slide projection, sign, or handout at your location, or you can send an email to participants.

We provide two different kinds of SMS texting phone numbers:

Regional numbers that can receive text messages from outside the country. Audience members that have cell phone plans outside that country will have to dial internationally and incur any applicable texting charges.

Local numbers that can only receive text messages from within the country. Audience members that are local to that country will not incur long distance texting charges and have a shorter number to dial.

You can test whether our regional numbers will accept texts from your country and carrier on our international SMS response page.

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The basics of getting started include: creating your first poll question, presenting the live results, and customizing the look and feel of your poll. You can also publish the results via email or a website.

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The ABCDs of Writing Instruction Objectives

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The ABCDs of Writing Instruction Objectives

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Bloom's Taxonomy: Why, How, & Top Examples

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Writing Good Multiple Choice Test Questions

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Writing Good Multiple Choice Test Questions

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Writing Good Multiple Choice Test Questions

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by Cynthia J. Brame Print Version Cite this guide: Brame, C. (2013) Writing good multiple choice test questions. Retrieved [todaysdate] from https://cft.vanderbilt.edu/guides-sub-pages/writing-good-multiple-choice-test-questions/. Constructing an Effective Stem Constructing Effective Alternatives Additional Guidelines for Multiple Choice Questions Considerations for Writing Multiple Choice Items that Test Higher-order Thinking Additional Resources Multiple choice test questions, also known as items,...

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QSEN - Peer Reviewed Teaching Strategies

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QSEN - Peer Reviewed Teaching Strategies

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Below is a listing of the peer-reviewed strategies published on our website. Each strategy submitted undergoes a blind peer-review by a volunteer QSEN Strategy reviewer. You will receive feedback on revisions from the reviewer and then submit your revisions. You can scroll through the listing or search the strategies by author, title, and keywords.

QSEN Teaching Strategies Director

Yolanda Nelson, EdD, MSNed, RN-BC, (December 2018 -- present) nelsony1@tcnj.edu

QSEN Practice Strategies Director

Bethany Robertson, DNP, CNM (December 2018 -- present) bethany.robertson@emory.edu

The materials on the QSEN Web site are freely available for educational use, but original content such as the strategies must be cited. Please read our Terms and Conditions before using this material.

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Below is a listing of the peer-reviewed strategies published on our website. Each strategy submitted undergoes a blind peer-review by a volunteer QSEN Strategy reviewer. You will receive feedback on revisions from the reviewer and then submit your revisions. You can scroll through the listing or search the strategies by author, title, and keywords.

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Teaching Strategies for Higher Level Thinking

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Teaching Strategies for Higher Level Thinking

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Active Learning Exercises to Engage Students

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Fundamentals of Nursing Co-Author Barbara L. Yoost, MSN, RN, CNS, CNE, ANEF shares ten ideas for infusing active learning into your classroom lessons.

1. Patient Teaching Pamphlets
Create a sample patient that has an illness or injury related to what you're currently covering in class. Then ask each student to develop an educational pamphlet, flyer, or mini brochure for that patient. Make sure students cover all the necessary information in their pamphlet such as: risk factors, signs and symptoms, when to call the primary care provider, treatments, prevention strategies, and online and community resources for further information. Encourage students to be creative with the design and writing of the piece to make the information engaging and understandable for the patient.

2. Ace® Wrap Relays
Divide the class into teams (2-4 teams depending on size of classroom and number of available patient mannequins or body parts). In the relay, each member of a team takes a turn at wrapping and unwrapping a specific body part of a "patient". The actual ace bandage serves as the baton as it is handed from one team member to the next. The team that finishes all of their wrappings effectively in the fastest amount of time wins. You may decide to have each student complete their bandage wrapping on the same body part for the same problem (e.g. every student performs a wrap on an amputation below the knee), or you can vary the body parts, problems, and wrap style depending on the relay round (e.g. student 1 from each team does a figure 8 wrap on a right leg with edema, student 2 does a spiral wrap on a sprained left ankle, and so on). For an extra challenge, have each student assess the wrapped extremity for circulation, sensation, and movement. You can even have students document their care electronically before moving on.

3. NCLEX Exam Authors
Break students into pairs and have them write ten different NCLEX exam-style questions on a specific nursing concept or class topic. Make sure students include a variety of wrong responses along with the correct answer. Then have students present their questions and response options. After classmates vote on which answer is correct, have the presenting pair reveal the correct answer and explain their rationales for both the right and wrong responses.

4. O2 Bingo
Introduce your class to O2 Bingo by creating bingo boards with oxygenation terms (think oximetry, CPAP, hypoxia, etc.). Then ask students questions and have them mark the answer on their boards. The bingo game can also be developed to cover a variety of different nursing concepts and related exemplars. For a creative end-of-the-year review idea, have each of your students develop their own bingo cards and questions surrounding a specific nursing concept. Then have the entire class play a round of bingo to review the concept.

5. Medication Commercials
Divide students into groups of two or three and have them write and perform medication commercials. You can have the entire class cover the same medication or have each group cover something different. After each group performs their commercial, have the class compare and discuss what they experience in the clinical area versus what they read about in research.

6. Unfolding Case Studies
Bring the subject to the center of your classroom by incorporating unfolding case studies into your lesson. Start off by providing basic assessment data on a patient. As class progresses, continue to reveal more information about that patient and their disease/disorder. Make sure students have their smartphones, tablets or laptops on hand to reference medication, diagnostic testing, and care planning point-of-care software.

7. Reading Reflections
Assign a particular section of the text to read for homework. Then at the beginning of the next class, have students write down: 1.) three things they learned from the reading, 2.) one way that learning might affect them in clinical practice, and 3.) one question they hope to have answered today in class. Have students hand in their written reflections, and then discuss the various takeaways as a class. Ask students to help answer their classmates' questions from the reading. This short exercise is a great way to ensure students complete the assigned reading ahead of time.

8. The Sensory Deprivation Experience
When covering nursing concepts such as functional ability or sensory perception, have students take turns experiencing the blind or deaf patient's point of view during simulation or a classroom activity by having the student wear a blindfold or earplugs respectively. Afterwards, have students discuss what they felt and learned from their sensory deprivation.

9. Name That Personal Care Item
Use this identification game to familiarize fundamentals students with the patient care items they will frequently encounter on the job. Start by collecting a variety of personal care items, such as a fracture pan, regular bed pan, catheter, etc., and set them on a table. Give each item a number and hold them up one item at a time. Then have students write down what they think the item is. This game can be used in place of a quiz where students individually write down the answers on a piece of paper to hand in. Or for an interactive review, divide the class into four teams and carry out the activity as if it were a round in a game show (first team to ring the bell gets to guess, and so on).

10. Clinical to Classroom
Each week, assign one student to write a case study based anonymously on a former clinical patient whose diagnoses relate to concepts being covered in readings and class. Have the student present his/her case study. Then allow classmates time to discuss their possible answers to the questions provided in the case study. Finally, have the author lead a discussion about the clinical patient case study and provide the "correct answers" that the authoring student prepared from required class readings, preparatory research, and his/her actual clinical experience with the patient. These can be submitted to you prior to class for review and you can then post it on the course website for all students to download prior to class.

For more resources on active learning and flipping your classroom click here.

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10 Active Learning Exercises to Engage Students | Elsevier Evolve

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Fundamentals of Nursing Co-Author Barbara L. Yoost, MSN, RN, CNS, CNE, ANEF shares ten ideas for infusing active learning into your classroom lessons. Patient Teaching Pamphlets Create a sample patient that has an illness or injury related to what you're currently covering in class.

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A. PATIENT / FAMILY CENTERED CARE: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.

Pain Management and Pain Service

Equipment: Curlin PainSmart Pump (PCA/PCEA)

Patient/Family Communication

B. TEAMWORK COLLABORATION: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

Communication-Handoff/Handover Process

Patient Transfer Within the Facility

Patient Transfer Outside the Facility

C. EVIDENCE BASED PRACTICE (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

Evidence Based Practice

D. QUALITY IMPROVEMENT: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems.

Core Measures

Immunization Screening in Adults

Venous Thromboembolism (VTE) Prophylaxis: VTE Prophylaxis and Anticoagulation

Nurse Sensitive Indicators:

Adult Fall Prevention: Post Fall and Post Fall Head Injury Care

Infection Prevention: Catheter Associated Urinary Tract Infection (CAUTI) Prevention

Equipment: Bladder Scanner

Infections Prevention: Central Line-associated Bloodstream Infection (CLASBI) Prevention

Skin Care and Wound Management

E. SAFETY: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

Blood/Blood Product Administration

Central Venous Catheters

Cardiopulmonary Monitoring

a. Equipment: EKG

b. Eauipment: Pulse Oximetry

c. Equipment: Doppler

d. Equipment: Vitl Sign Device

a. Equipment: Lead Placement

b. Equipment: 12 Lead Recording

c. Equipment: Analysis

d. Equipment: Storage

e. Equipment: Central

f. Equipment: Mirrored Monitor Station

Disruptive Behavior: Constant Observation Aide (COA), Suicide Assessment and Precautions, De-escalation Process, and Code Gray, Medical Incapacity

Changing Patient Condition: Rapid Response

Equipment: Zoll -AED, Defibrillator, Cardiovert, Pacer, ETCO2

Equipment: Emergency Cart: Code Cart Contents and Location

Equipment: Accu-Chek Inform II

Intravenous Insertion and Venipuncture

Equipment: Vein Finder AV400

Equipment: Infusion Pump (Sigma)

Lab and Specimen Handling

Medication Management and Administration

Respiratory Management and Oxygen Administration

Equipment: Oxygen delivery devices

Safe Patient Mobilization: Safe Patient Handling, UMOVE BMAT

Temperature Management:

F. INFORMATICS: Use information and technology to communicate, manage knowledge, mitigate error and support decision making.

Documentation Standards and Audits

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QSEN (Quality and Safety Education for Nurses) Competency-based Assessment

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A. PATIENT / FAMILY CENTERED CARE: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. Pain Management and Pain Service Equipment: Curlin PainSmart Pump (PCA/PCEA) Patient/Family Communication B.

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One of the main 21 st century components that teachers want their students to use are higher-order thinking skills. This is when students use complex ways to think about what they are learning.

Higher-order thinking takes thinking to a whole new level. Students using it are understanding higher levels rather than just memorizing math facts. They would have to understand the facts, infer them, and connect them to other concepts.

Here are 10 teaching strategies to enhance higher-order thinking skills in your students.

1. Teaching Strategies to Help Determine What Higher-Order Thinking is

Help students understand what higher-order thinking is. Explain to them what it is and why they need it. Help them understand their own strengths and challenges. You can do this by showing them how they can ask themselves good questions. That leads us to the next strategy.

2. Encourage Questioning

A classroom where students feel free to ask questions without any negative reactions from their peers or their teachers is a classroom where students feel free to be creative. Encourage students to ask questions, and if for some reason you can't get to their question during class time, then show them how they can answer it themselves, or have them save the question until the following day.

3. Connect Concepts

Lead students through the process of how to connect one concept to another. By doing this you are teaching them to connect what they already know with what they are learning. This level of thinking will help students learn to make connections whenever it is possible, which will help them gain even more understanding. For example, let's say that the concept they are learning is "Chinese New Year." An even broader concept would be "Holidays," and if you take it one step further it can be "Celebrations." Each small concept can be connected to a bigger, broader concept.

4. Teach Students to Infer

Teach students to make inferences by giving them "Real-world" examples. You can start by giving students a picture of a people standing in line at a soup kitchen. Ask them to look at the picture and focus on the details. Then, ask them to make inferences based on what they see in the picture. Another way to teach young students about how to infer is to teach an easy concept like weather. Ask students to put on their raincoat and boots, then ask them to infer what they think the weather looks like outside.

5. Use Graphic Organizers

Graphic organizers provide students with a nice way to frame their thoughts in an organized manner. By drawing diagrams or mind maps, students are able to better connect concepts and see their relationships. This will help students develop a habit of connecting concepts.

6. Teach Problem-Solving Strategies

Teach students to use a step-by-step method for solving problems. This way of higher order thinking will help them solve problems faster and easier. Encourage students to use alternative methods to solve problems as well as offer them different problem-solving methods.

7. Encourage Creative Thinking

Creative thinking is when students invent, imagine, and design what they are thinking. Using your creative senses help students process and understand information better. Research shows that when students utilize creative higher order thinking skills, it indeed increases their understanding. Encourage students to think "Outside of the box."

8. Use Mind Movies

When concepts that are being learned are hard, encourage students to create a movie in their mind. Teach them to close their eyes and picture it like a movie playing. This way of higher order thinking will truly help them understand in a powerful, unique way.

9. Teach Students to Elaborate Their Answers

Higher-order thinking requires students to really understand a concept not repeat it or memorize it. Encourage students to elaborate their answers and talk about what they are learning. Ask parents to reinforce this at home, as well by asking the right questions that make students explain their answers in more detail, or to answer their child's question with a more detailed response.

10. Teach QARs

Question-Answer-Relationships, or QARs, teach students to label the type of question that is being asked, then use that information to help them formulate an answer. Students must decipher if the answer can be found in a text or on the Internet, or if they must rely on their own prior knowledge to answer it. This strategy has been found to be effective for higher-order thinking because students become more aware of the relationship between the information in a text and their prior knowledge, which helps them decipher which strategy to use when they need to seek an answer.
How do you enhance higher order thinking skills in your classroom? Do you have any tips that you would like to share? Please feel free to leave a comment in the section below, we would love to hear your thoughts on this topic. Janelle Cox is an education writer who uses her experience and knowledge to provide creative and original writing in the field of education. Janelle holds a Master's of Science in Education from the State University of New York College at Buffalo. She is also the Elementary Education Expert for About.com, as well as a contributing writer to TeachHUB.com and TeachHUB Magazine. You can follow her at Twitter @Empoweringk6ed, or on Facebook at Empowering K6 Educators.

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Teaching Strategies that Enhance Higher-Order Thinking

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One of the main 21 st century components that teachers want their students to use are higher-order thinking skills. This is when students use complex ways to think about what they are learning. Higher-order thinking takes thinking to a whole new level. Students using it are understanding higher levels rather than just memorizing math facts.

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The National Database of Nursing Quality IndicatorsTM (NDNQI®) is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level. Linkages between nurse staffing levels and patient outcomes have already been demonstrated through the use of this database. Currently over 1100 facilities in the United States contribute to this growing database which can now be used to show the economic implications of various levels of nurse staffing. The purpose of this article is to describe the work and accomplishments related to the NDNQI as researchers utilize its nursing-sensitive outcomes measures to demonstrate the value of nurses in promoting quality patient care. After reviewing the history of evaluating nursing care quality, this article will explain the purpose of the NDNQI and describe how the database has been operationalized. Accomplishments and future plans of the NDNQI will also be discussed.

Citation: Montalvo, I., (September 30, 2007) "The National Database of Nursing Quality Indicators TM (NDNQI ®)" OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 2.

DOI: 10.3912/OJIN.Vol12No03Man02

Key Words: nursing-sensitive indicators, quality, nurse staffing, patient outcomes, nursing outcomes, performance measurement

Quality is a broad term that encompasses various aspects of nursing care. Various health care measures have been identified over the years as indicators of health care quality ( American Nurses Association, 1995; Institute of Medicine, 1999, 2001, 2005; Joint Commission, 2007). In 2004, the National Quality Forum (NQF), via its voluntary consensus standards process, endorsed 15 national standards to be used in evaluating nursing-sensitive care. These standards are now known as the NQF 15 ( Kurtzman & Corrigan, 2007). The purpose of this article is to describe the work and accomplishments related to the National Database of Nursing Quality Indicators TM (NDNQI ®) as researchers utilize its nursing-sensitive outcomes measures to demonstrate the value of nurses in promoting quality patient care. After reviewing the history of evaluating nursing care quality, this article will explain the purpose of the NDNQI and describe how the database has been operationalized. Accomplishments and future plans of the NDNQI will also be discussed.
History of Evaluating Nursing Care Quality
Evaluating the quality of nursing practice began when Florence Nightingale identified nursing's role in health care quality and began to measure patient outcomes. She used statistical methods to generate reports correlating patient outcomes to environmental conditions ( Dossey, 2005; Nightingale, 1859/1946). Over the years, quality measurement in health care has evolved. The work done in the 1970s by the American Nurses Association (ANA), the wide dissemination of the Quality Assurance (QA) model ( Rantz, 1995), and the introduction of Donabedian's structure, process, and outcomes model ( Donabedian, 1988, 1992) have offered a comprehensive method for evaluating health care quality.

The workforce restructuring and redesign prevalent in the early 1990s demonstrated the need for the ANA to evaluate nurse staffing and identify linkages between nurse staffing and patient outcomes. The workforce restructuring and redesign prevalent in the early 1990s demonstrated the need for the ANA to evaluate nurse staffing and identify linkages between nurse staffing and patient outcomes. In 1994 the ANA Board of Directors asked ANA staff to investigate the impact of these changes on the safety and quality of patient care. In 1994, ANA launched the Patient Safety and Quality Initiative ( ANA, 1995). A series of pilot studies across the United States were funded by ANA to evaluate linkages between nurse staffing and quality of care ( ANA, 1996a, 1997, 2000a, 2000b, 2000c). Multiple quality indicators were identified initially. Evidence of the effectiveness of these indicators was used to adopt a final set of 10 nursing-sensitive indicators to use in evaluating patient care quality ( Gallagher & Rowell, 2003). Implementation guidelines were subsequently published ( ANA, 1996b, 1999).

Nursing-sensitive indicators identify structures of care and care processes, both of which in turn influence care outcomes. Nursing-sensitive indicators are distinct and specific to nursing, and differ from medical indicators of care quality. For example, one structural nursing indicator is nursing care hours provided per patient day. Nursing outcome indicators are those outcomes most influenced by nursing care.
Purpose of the NDNQI®
In 1998, the National Database of Nursing Quality Indicators was established by ANA so that ANA could continue to collect and build on data obtained from earlier studies and further develop nursing's body of knowledge related to factors which influence the quality of nursing care. Linkages between nurse staffing and patient outcomes had already been identified, but continued data collection and reporting was necessary to evaluate nursing care quality at the unit level and thus fulfill nursing's commitment to evaluating and improving patient care.

Nursing's foundational principles and guidelines identify that as a profession, nursing has a responsibility to measure, evaluate, and improve practice. This is stated in two of nursing's guiding documents:

The Code of Ethics for Nurses with Interpretative Statements states: The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (ANA, 2001, p.12).

Nursing: Scope & Standards of Practice, Standard 7 states: The registered nurse systematically enhances the quality and effectiveness of nursing practice (ANA, 2004. p. 33).

The Utilization Guide for the ANA Principles for Nurse Staffing recognizes that in order to measure sufficiency of staffing on an ongoing basis, at a minimum, unit level nursing-sensitive structure, process, and outcome indicators need to be collected ( ANA, 2005). NDNQI's mission is to aid the nurse in patient safety and quality improvement efforts... NDNQI's mission is to aid the nurse in patient safety and quality improvement efforts by providing research-based, national, comparative data on nursing care and the relationship of this care to patient outcomes.
Operationalization of the National Database
The NDNQI ® database is managed at the University of Kansas Medical Center (KUMC) School of Nursing under contract to ANA with fiscal and legal support provided by KUMC Research Institute (KUMCRI). A health care facility that is interested in joining the NDNQI submits a signed contract and fee, based on hospital size, to KUMCRI, along with information on the person who will be the facility's NDNQI ® primary point of contact. This person is then identified as the NDNQI Site Coordinator. The NDNQI Site Coordinator serves as the interface between the participating facility and the NDNQI liaisons working at the University of Kansas. The NDNQI ® liaisons provide ongoing assistance and support to health care facilities at multiple levels. For example they provide help in identifying nursing units appropriately for data entry; offer web-based, data-entry tutorials; conduct pilot testing; and answer questions about definitions and the reading of reports. NDNQI ® researchers are also available to answer questions related to the database or the nursing measures.

Education on NDNQI and nursing-sensitive indicators has been ongoing for participating facilities since 1999. Facilities have quarterly conference calls with NDNQI ® staff to review any changes or updates to the indicators or database. They also have the opportunity to participate in pilot studies performed when an indicator is being evaluated for implementation.

Once access to the database has been provided, the facility NDNQI ® Site Coordinator will work with NDNQI staff from the University of Kansas to correctly classify the nursing units. This is an important step to ensure nursing units are classified appropriately prior to data entry. The facility NDNQI Site Coordinator and other authorized hospital staff also complete web-based tutorials to learn about each indicator prior to initial data submission. The facility NDNQI Site Coordinator has continuous access to the indicator definitions and is responsible for aligning the hospital data collected to NDNQI definitions. The facility NDNQI Site Coordinator has continuous access to the indicator definitions and is responsible for aligning the hospital data collected to NDNQI definitions. On average, it takes three months to join the database and start data submission. The NDNQI is then dependent on hospitals correctly submitting the data on a quarterly basis. All data is submitted electronically via the intranet in a secure website or by XML submission. Data checks and error reports are conducted on an ongoing basis by participating facilities and by NDNQI staff to ensure data integrity.

As of the writing of this article, the NDNQI has implemented six of the ten original ANA-endorsed NDNQI indicators (See Table 1). The initial set of indicators used in establishing the database was selected based on feasibility testing. These indicators included: Falls, Falls with Injury, Nursing Care Hours per Patient Day, Skill Mix, Pressure Ulcer Prevalence, and Hospital-Acquired Pressure Ulcer Prevalence. The RN job satisfaction indicator was pilot tested in 2001 and subsequently implemented in 2002. The RN satisfaction survey is an important indicator to assist nursing leaders and staff in evaluating the work environment so as to facilitate nursing retention and recruiting efforts.

Pediatric and psychiatric indicators have been added more recently because participating hospitals requested indicators for these areas. Additional NQF endorsed measures ( Table 1) were then added to the database because these represented additional nursing measures available that had already gone through a consensus measure approval process. ANA supported the addition of these measures to the database because they were of interest nationally to the nursing profession and were in concert withANA's seminal work and ongoing support of nursing measures.

Implementing an indicator is a multi-step process ( Table 2) that includes evaluating the evidence that a specified indicator is nurse sensitive and then pilot testing ( Table 3) of the indicator by participating facilities. In addition, ...there is ongoing monitoring and testing for validity and reliability per NDNQI standard operating procedure. there is ongoing monitoring and testing for validity and reliability per NDNQI standard operating procedure. An outcome indicator is deemed to be nursing sensitive if there is a correlation or multivariate association between some aspect of the nursing workforce or a nursing process and the outcome. The NDNQI utilizes state-of-the-science methods, such as the hierarchical mixed model, to assess the strength of correlation between nursing workforce characteristics and outcomes ( Gajewski et al., 2007; Hart, et al., 2006).

Table 2. Indicator Development Process

1. Review scientific literature for: (a) evidence that some aspect of nursing case has an effect on a patient outcome; (b) specific definitions of the indicators; and (c) evidence that the indicators can be validly and reliably measured

2. Collect information from researchers in the field on threats to reliability and validity

3. Conduct expert review of draft indicator definitions, data collection guidelines, and data collection forms

4. Distribute revised definitions, guidelines, and forms to clinical experts for comments on face validity and feasibility of reliable data collection

5. Incorporate clinical expert feedback and develop revised versions of definitions, guidelines, and forms

6. Conduct a pilot study (Table 3) using the draft data collection materials and review data; also interview hospital study coordinators to identify additional threats to reliability and validity

7. Finalize definitions, data collection guidelines, and forms

8. Train database participants in standardized data collection practices

1. Develop the indicator with draft guidelines and data collection instruments

2. Recruit pilot testers via e-mail and phone

3. Select pilot sites from those interested. Sites are selected for hospital/unit diversity

4. Guide pilot sites in collecting data according to the draft guidelines

5. Analyze data submitted by pilot sites

6. Collect written and telephone evaluations to assess for clarity, feasibility, and assessment of threats to validity and reliability

7. Analyze pilot data for indicator refinement

8. Finalize guidelines and instruments for dissemination

Quarterly Reports are downloaded electronically from the web by participating facilities. Reports can be downloaded in Adobe PDF, or Microsoft Excel format to facilitate data sharing and dissemination within a given institution. Figure 1 provides a sample of two tables from the report. The reports range from 25-200+ pages based on the number of nursing units and indicators for which hospitals submit data. The reports provide the most current eight quarters worth of data and a rolling average of those eight quarters with national comparisons at the unit level based on patient type, unit type, hospital bed size, and statistical significance of unit performance. For example, patient falls with injury could be reported for each adult medical unit of a 100-199 bed facility. The means for all medical units in a given-size facility can be compared with national standards for a given, nursing-sensitive indicator. The process measures associated with falls are collected and reported as well as the outcome measure of a patient fall.

Figure 1 - Sample Tables from NDNQI Reports

The significance of offering the reports at the unit level is that such reports provide data regarding the specific site where the care occurs and provides a better comparison among like units. The significance of offering the reports at the unit level is that such reports provide data regarding the specific site where the care occurs and provides a better comparison among like units. Nursing leaders at participating facilities have used the information to advocate for more staff or a different mix of staff based on their comparisons of units in comparable facilities nation wide. Staff are also able to identify whether their performance improved after they intervened in an area needing improvement, e.g., a decrease in the fall rate due to implementation of a new protocol.

Some facilities join NDNQI as part of their Magnet TM Journey to report nursing-sensitive indicators. The Magnet facilities represent about 20% of the database. The remaining 80% of NDNQI-participating facilities join because they believe in the value of evaluating the quality of nursing care and improving outcomes, activities which are both basic responsibilities of the profession. NDNQI is also used to aid in the recruitment and retention of nurses by hospitals that use the annual RN Survey data and quarterly data to improve work environments, to staff based on patient outcomes, and to meet regulatory or state reporting requirements.
Broad Accomplishments
NDNQI accomplishments include development of nationally accepted measures to assess the quality of nursing care, improvements in training procedures for data submission, identification of nursing workforce structures and processes that influence outcomes, and sharing best practices for improving outcomes. Each will be discussed in turn. Nursing leaders at participating facilities have used the information to advocate for more staff...

To date the NDNQI has already developed a number of standards. Four of the 15 standard nursing measures endorsed by the NQF have been NDNQI measures. Thirteen indicators already have been implemented in NDNQI, and at the time of this writing three additional measures, which are also NQF-endorsed measures, are scheduled for implementation. Of the 13 implemented indicators, eight are NQF consensus measures. NQF uses a consensus process to endorse measures. This process includes (a) consensus standard development, (b) widespread review, (c) member voting and member council approval, (d) board of directors action, and (e) evaluation. The importance of the NQF-endorsed indicators is that they provide a standard measure for evaluating nursing care and are the only nursing measures that have been endorsed for public reporting.

Data training procedures and submissions have advanced from a telephone call for 1:1 training and submission using a CD, to use of comprehensive, web-based tutorials training participants to submit data using electronic means. Data submission now involves specification of unit types and various patient types, such as adult, pediatric, neonatal, psychiatric, and rehabilitation patient populations.

Research on the database has yielded meaningful information on both workforce characteristics which influence quality outcomes and the importance of evaluating the data based on unit type. Identification of important correlations between structures and processes and observed nursing outcomes can help facilities improve their nursing care outcomes.Dunton et al. ( 2004) evaluated nurse staffing and patient falls and noted important correlations. They observed that lower fall rates were associated with higher staffing on certain types of units, and noted a strong relationship between fall rates, nursing hours, and skill mix. Hart, et al.( 2006) studied the incidence of pressure ulcers among NDNQI hospitals, and reported a difference in quality outcomes based on the nursing workforce element of certification. As a result of the Hart et al. study an additional, web-based tutorial on pressure ulcers was created by NDNQIto educate the staff nurse on wound assessment. It is available publicly on the NDNQI web-site for any nurse to complete. Both of these studies demonstrated the value of reporting nursing-sensitive indicator data at the unit level, recognizing that variability of outcomes occurs at the unit level based on patient type, nurse staffing, and the nursing workforce characteristics. The NDNQI database enables researchers to identify various nursing workforce elements that can impact patient outcome, such as nurse staffing, skill mix, and specific nursing processes. It also enables researchers to identify process elements that can influence patient outcomes. Identification of important correlations between structures and processes and observed nursing outcomes can help facilities improve their nursing care outcomes. The database provides the end user with a powerful tool to aid in decision making related to improving the nursing work environment and patient outcomes.

...80% of NDNQI-participating facilities join because they believe in the value of evaluating the quality of nursing care and improving outcomes, activities which are both basic responsibilities of the profession. NDNQIstaff have also helped facilities improve patient care by sharing best practices. In 2006 NDNQIstaff identified facilities that had sustained an improvement in a given nursing-sensitive indicator. These facilities were asked to share what they had done to bring about this improvement. Fourteen facilities were profiled in a monograph identifying their experience with the database, their use of the data, and improvement strategies they had implemented to improve nursing performance in a given measure ( Montalvo & Dunton, 2007). For example, in one facility the hospital-acquired pressure ulcer (HAPU) rate dropped from 6.31 to 3.04 after implementing a quality improvement process that included assigning wound/ostomy/ continence specialists to specific nursing units to help all staff improve their surveillance for HAPUs and adopt a zero tolerance for HAPU. The opportunity for varying-size facilities to share these best practices adds to nursing's knowledge base and helps nurses nation wide to improve nursing practice and patient outcome. The First Annual NDNQI Data Use Conference was held in January 2007 and was highly successful with 900 attendees being able to walk away with practical tools and tips in utilizing NDNQI data and to improve nursing-sensitive indicator outcomes. The monograph by Montalvo and Dunton, along with the annual national conference, have aided in disseminating such helpful information to all interested parties.

The current consumer-driven health care environment requires accountability for the health care decisions made and the impact of these decisions on patients. Although direct financial cost/benefits have not been fully calculated with NDNQI globally, the staff nurses and nurse leaders now have a valuable nursing tool to aid them in decision making about staffing, skill mix, patient care processes, and workforce characteristics that affect patient outcomes, thus influencing directly and indirectly the cost of patient care. The facility now has the data necessary to calculate their cost/benefit ratio based on their improvements and outcomes.
Future Plans and Goals for NDNQI®
The NDNQI database continues to grow in the number of facilities participating and in methodological sophistication. The database has grown from the original 30 facilities to over 1100 facilities in 2007, and ongoing investment and database enhancements continue. Two key developments are slated to begin in 2007. One is to develop methods for measuring unit-level acuity. This will provide mixed acuity units (units having more than 10% of patients representing a different patient population, such as rehabilitation patients on medical units [NDNQIoperational definition, 2007]) and universal bed units (those having patient rooms equipped to care for any patient regardless of acuity [ Brown, 2007]) with the ability to receive comparisons from NDNQI.

The second enhancement is to improve reporting features of NDNQI, so that more finite or granular comparisons of a very specific type of unit can be made. An example of a more finite comparison for particular facilities would be comparing coronary critical care units in the 100-bed to 199-bed hospitals. More enhanced reporting will provide more specific comparisons, the ability to download and post different sections of the report, new color graphics, single report cards, and hospital-level summaries. These value-added enhancements will provide the end user with a more powerful tool to evaluate nursing care, improve quality, and influence outcomes for both the patient and the nursing staff alike.

New indicators are added to the database on an annual basis. Additionally, over the next 18 months, existing indicators in the database will become available for all appropriate nursing units. For example, the current psychiatric assault indicator could be pertinent in the Emergency Department (ED) because the ED is a point of entry for these patients. As the demand for data increases, expanding existing indicators to relevant areas will facilitate the ability of facilities to respond to patient and staff needs.
Conclusion
Researchers will also continue to benefit from these enhancements. These developments will enable researchers to fine-tune their research questions and identify additional associations between nursing workforce characteristics and processes and the observed patient outcomes.

The NDNQI has made considerable progress since the ANA Board of Directors asked ANA staff to investigate the impact of workforce restructuring and redesign on patient care and to quantify the relationship between nurse staffing and patient outcomes. Today's national spotlights on patient safety and public reporting have increased the need for nursing to collect and monitor data related to patient outcomes. It is also critical to continue these efforts to ensure nursing has the appropriate workforce to render the care necessary to optimize patient outcomes at the unit level. NDNQI studies have demonstrated the value of nursing care and the significance of nursing's contribution to positive patient outcomes. NDNQI data now has the validity and reliability to be used to evaluate nursing care, improve patient outcomes, and identify the linkages between nurse staffing and patient outcomes at the unit level. NDNQI has indeed become the seminal nursing database that is used to influence nursing policy and improve nursing care.

Isis Montalvo, MS, MBA, RN
E-mail: Isis.Montalvo@ana.org

Isis Montalvo is Manager, Nursing Practice & Policy at the American Nurses Association (ANA). She is primarily responsible for providing oversight to the National Database of Nursing Quality Indicators™ (NDNQI®) in which over 1100 hospitals currently participate ( www.nursingquality.org). Ms. Montalvo has over 20 years experience in multiple areas of clinical and administrative practice with a focus in critical care and performance improvement. As a former NDNQI Site Coordinator, Quality Specialist, and Nursing Research Chair at a large urban facility she brings expertise in data analysis, performance improvement, and nursing care evaluation. In 1996, she received her Master's in Business Administration from the University of Baltimore in Maryland and her Master's of Science in Nursing Administration from the University of Maryland . She is a Critical Care Registered Nurse (CCRN) Alumnus and a member of the American Association of Critical Care Nurses, the American Society of Association Executives/The Center for Association Leadership, the National Association for Healthcare Quality, and Phi Kappa Phi and Sigma Theta Tau honor societies.

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© 2007 OJIN: The Online Journal of Issues in Nursing
Article published September 30, 2007

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the value of rns: how can we communicate our economic worth?

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The National Database of Nursing Quality Indicators

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The National Database of Nursing Quality IndicatorsTM (NDNQI®) is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level. Linkages between nurse staffing levels and patient outcomes have already been demonstrated through the use of this database.