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TRIPURA INSTITUTE OF PARAMEDICAL SCIENCES, Nursing

SUBJECT: - NURSING EDUCATION

ASSIGNMENT ON: - Non Standardized tool.

DATE OF SUBMISSION: 05/02/2023

SUBMITTED TO- SUBMITTED BY-

Ms .Anupa Malakar (Asso. PROFESSOR) MS. Susmita sen
HOD. Dept. of Child Health Nursing. M.ScNURSING, 1ST SEMESTER.
TIPS, NURSING ROLL NO- 12 TIPS, NURSING
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NON STANDARDIZED TOOL:-

A non-standardized test is one that allows for an assessment of an individual's abilities or

performances, but doesn't allow for a fair comparison of one student to another. This type of test
contrasts standardized tests, such as state educational development tests and college entrance
exams like the SAT and ACT.

Types of TEST:-
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TEACHER MADE TEST (NON-STANDARDIZED):-

These are very useful in evaluating the student's progress to report parents and
administrations. A Non Standardized Test is one that is not given to give of people initially to
standardize it. The most common types of tests that are not standardized are the classroom tests
given by teachers all the time.

Teacher-made Paper-and-pencil Tests:

Although teachers use many techniques in evaluating students, probably the most popular
is the written paper-and-pencil test that they themselves construct. These usually consist of essay
or multiple-choice items. The multiple choices, paper-and-pencil tests are probably the most
frequently used test, with other types such as true/false, essay and performance tests.

Uses of Teacher-made Tests

 To know the ability and achievements of students

 Helps the teacher to assess the strengths and weaknesses of the student
 Motivates the students
 Provides continuous evaluation and feedback to the teacher
 Helps to achieve particular objectives
 Helps the teacher to adopt better instructed methods.

Limitations

 Tests are often ambiguous and unclear.

 They are either too short or too lengthy.
 Tests do not cover the entire content.
 Supervision is not proper.
 Lot of scope for copying.
 Conducted as rituals only.
 Answer books not marked with care.

CONSTRUCTION PROCEDURE OF AN ACHIEVEMENT TEST:-

If a test has to be really made valid, reliable and practical, then it will have to be suitably
planned. For qualitative improvement in the test will have to be effected. For this, the following
facts should be kept in view:

Previous available 10 years exams should be kept in view so that test can be planned.
Skill will have to be acquired in constructing and writing different types of questions. For
it is required thoughtful thinking, determination of teaching objectives, analysis of
content and types of questions to be given.
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General Guidelines for Constructing Test Items:-

 Make the first test item easy. Place items from easy to difficult or periodically
place easier items in the test.
 Consider placing material on the test to parallel the content coverage sequence.
 All items of the same type should be together.
 Don't use more than two item types, in most cases.
 For elementary students, use one item type.
 Include directions for the total test and each test section. Include instructions how
to respond and the point value for questions in each section.
 Try not to include information that will offer answers to previous questions.
 Try to put all matching on one page (etc.) so students do not have to turn pages to
match answers and responses.
 Title the test and each section.
 Write test items that measure stated objectives.
 Test only one idea or principle in each item.
 List items in a systematic order.
 Do not provide clues in one item to the answer of another item.
 Arrange the correct alternatives for multiple-choice items randomly.
 Indicate the source of an opinion or authority, if an item is based on that
information.
 Avoid ambiguous, trick, or trivial questions.
 Keep the reading difficulty of test items low unless your aim is to measure verbal
and reading abilities.
 Group questions according to item type so students do not continuously shift
response patterns.
 Do not use a series of interdependent questions in which the answer to one item
depends upon knowing the correct answer to another item.

General Precautions in Test Construction:-

Ebel, in his book Measuring Educational Achievement, has suggested the following precautions
in test construction:

1. It should be decided when the test has to be conducted in the context of time and frequency.
2. It should be determined how many questions have to be included in the test.
3. It should be determined what types of questions have to be used in the test.
4. Those topics should be determined from which questions have to be constructed. This
decision is taken keeping in view the teaching objectives.
5. The level of difficulty of questions should be decided at the beginning of the test.
6. It should be determined if any correction has to be carried out for guessing.
7. The format and type of printing should be decided in advance.
8. It should be determined what should be the passing score.
9. In order to control the personal bias of the examiner, there should be a provision for
central evaluation. A particular question should be checked by the same examiner.
10. A rule book should be prepared before the evaluation of the scripts.
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Steps in Construction of the Test:-

Following steps should be followed to make achievement test objective, valid and reliable.

First Step:-

Selection of Teaching Objectives for Measurement: At first those teaching objectives

should be selected from all teaching objectives of subject teaching which have to be made the
basis for test construction. There can be several causes of selecting these teaching objectives
which have to determine related teaching, such as how much content has been studied, what is
the need of student, what is the importance of specific topics in the content etc. For it, the
following table can be used:

Teaching Objectives Selected Teaching Reason For

Objectives Selection
1. All objectives of the Cognitive 1. knowledge
domain(Knowledge,
Comprehension, Application,
Analysis, Synthesis, Evaluation)

2. All objectives of the affective 2. Comprehension

domain (receiving, responding,
valuing, conceptualization)

3. All skills of Psychomotor domain 3.Application(Drawing)

(drawing skill, computational skill,
constructional skill, observational
skill, problem- solving skill)

Second Step

Assigning Weightage to Selected Objectives:

After these objectives have been selected, a teacher assigns Weightage to these
objectives, keeping the tasks done and importance of objectives. It is desirable to use the
following table.
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Sl no. Selected Score Percentage

Teaching
Objectives
1. Knowledge 10 20
2. Understanding 20 40
3. Application 8 16
4. Analysis 5 10
5. Synthesis 5 10
6. Evaluation 2 4
Total 50 100

Third Step

Weightage to Content: Content is used as the means of realizing the objectives and
questions have to be constructed on its basis. Therefore, it becomes necessary give Weightage to
it. There is a distinction in the nature, importance and scope of each topic. Therefore, ne
Weightage should be given to these facts in view se the test would not represent the whole
subject.

Sl No. Topic Number of Score Percentage

items
1. ---

2. ---

3. ---

4. ---

5. ---

Example:- Weightage of Contect.

Sl Subject Number of itens Marks %

No. Topic
1. I 15 30
2. II 10 20
3. III 10 20
4. IV 5 10
5. V 10 20
Total 50 100
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Fourth Stage

Giving Weightage to the Type of Items In this step, a teacher determines the
number of items, their relatives marks. For it, it would be convenient to use following table:

SL No. Types Of Items National of Score Percentage

Items
1. Long answer type

2. Short answer type

3. Objective type

Example of Weight of content area

Sl Form of question No. of Marks % age

No. question
1. Objective Types 25 25 50
2. Short answer types 5 15 30
3. Long easy type 1 10 20
Total 31 50 100

Fifth Step

Determining Alternatives:-

At this level, it is determined how many alternatives or options should be given according
to the type of questions. Giving alternatives influences the reliability and validity of a test;
therefore, it is suggested that alternatives should not be given in objective type questions, while
in essay type questions only internal choice can be given.

Sixth Step

Division of Sections:

If the scope or types of questions are uniform, then it is not necessary to divide the test e
into sections. However, if it is diverse and different types of questions have been specified and
the nature of the test seems to be heterogeneous, then a separate section should be made
comprising each type of item.
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Sl No. Selections Type of items Score Percentage

1. A Objectives types

2. B Long answer type

3. C Short answer types

Seventh Step

Estimation of Time:

At this step estimation of the total time the whole test is likely to calculate. Time is
estimated on the basis of the type and number of items. Some time should be reserved for
distribution and collection of answer sheets. The following table can be used for convenience.

Sl No. Types of items Number of Time (in

items minutes)

1. Objectives Types

2. Long answer type

Short answer type

3.

Eighth Step

Preparation of the Blueprint:

A blueprint provides a bird's eye view of the entire test. In it we can see the e, topics,
teaching objectives, and types of questions, number of items and distribution of scores and their
mutual relationships. A blueprint is the basis for test construction. A format is given below:
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Sl Teacher Knowledge Comprehension Application Skill

No. objectives

Types of (L)(S)(O) (L)(S)(O) (L)(S)(O) (L) (L) (S) (O)

Question
Topic (S)

1.

2.

3.

4.

L- Long Answer Type S- Short Answer Type O- Objective Answer Type.

For Example a test blueprint for unit on oxygenation can be prepared as

shown:-

Sl Content Knowledge Application Analysis Evaluation Total

No. comprehen synthesis Score
sion

1. Principles 2 2 2 6

2. Factors affecting 3 3 4 10

3. Patho- 3 3 4 10
physiophysiology

4. Assignment 1 3 4 2 10

5. Nursing Measures 3 3 4 10

6. Evaluation of care 1 1 2 4

Total items 9 15 18 8 50
Test blueprint for unit on oxygenation.
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Ninth step

Preparation of Score Key

A score key increases the reliability of a test, so that the test constructor should provide the
procedure for scoring the answer script. Directions must be given whether the scoring will be
made by a scoring key (When the answer is recorded on the test paper) or by scoring stencil
(when the answer is recorded on a separate answer sheet) and how marks will be awarded to the
test items.

In case of essay type items it should be indicated whether to score with 'point method' or
with the 'rating method'. In the point method, each answer is compared with a set of ideal
answers in the scoring key. Then a given number of points are assigned. In the rating method, the
answers are rated on the bases of degrees of quality and determine the credit assigned to each
answer.

When the students do not have sufficient time to answer the test or the students are not
ready to take the test at that particular time. They guess the correct answer. In that case, to
eliminate the effect of guessing some measures must be employed. Thus, in order to bring
objectivity in a test, it is essential that a tester should be fully clear about the type of answer
expected from a question. For this, if they are acquainted with the right answers. Then diversity
in scoring can be eradicated.

1. For objective Type:-

Sl No. Item Serial Answer Score

2. For Long Answer & short Answer Type:-

Sl No. Item Serial Outline of Score Remarks

Answer

First Tryout of The Test

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At this stage the initial format of the test is administered to a small representative sample.
After that the process too item analysis is used to calculate difficulty level and discriminative
value. There are a variety of techniques for performing an item analysis, which is often used, for
example, to determine which items will be kept for the final version of a test. Item analysis is
used to help build reliability and validity are 'into' the test from the start Item analysis can be
both qualitative and quantitative The former focuses on issues related to the content of the test,
e.g. content validity. The latter primarily includes measurement of item difficulty and item
discrimination.

An item's difficulty level is usually measured in terms of the percentage of examinees

who answer the item correctly. This percentage is referred to as the item difficulty index, or 'p'.
Item discrimination refers to the degree to which items differentiate among examinees in terms
of the characteristic being measured (e.g. between high and low scorers). This can be measured
in many ways. Details of item analysis are discussed in detail in unit VI.

This initial format is administered to a small representative sample group. After that the
process of item analysis is used in order to calculate the difficulty level, discriminative value and
alternative (in multiple choice items). First of all in the context of multiple choice items the
appropriate choice is also selected and that alternative is rejected which has been opted by the
least number of students.

Generally, a test is constructed for average students naturally the division, according to
ability grouping is an essentiality. Generally the ability distribution used normal probability
curve provided the basis for the distribution.

In the context of difficulty level, the following difficulty levels are suggested for the
selection of questions as per Katz (1959) also recommendation.

Sl No. Types of items Difficulty level %

1. Long answer type 50%

2. Alternatives 5 60%
3. Alternatives 4 62%
4. Alternatives 3 66%
5.
Alternatives 2 75%

Example of weight Age of Difficulty Level:-

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Sl No. Level Of Difficulty Marks %

1. Easy 25 25
2. Average 5 15

3. Difficulty 1 10

Total 31 50

Preparation of Final Test

The test will provide useful information about the students' knowledge of the learning
objectives. Considering the questions relating to the various learning objectives as separate
subtests, the evaluator can develop a profile of each student's knowledge of or skill in the
objectives.

The final test is constructed after the above analysis For this a suitable format is prepared
and norms are specified. Also, instructions for examinees be prepared.

The test constructed in accordance to the above eferred procedure will definitely assume
a purpose or n idea of what is good or desirable from the standpoint f individual or society or
both.

Problems with Test:-

The most common problem with teacher- made tests is that the criterion of performance
may never have been clearly set. Another problem is that students often do not know they are
going to be tested on, in other words, they do not know what the performance criteria is. Teacher
made test are often subject to question because they are going to be tested-in other words, they
do not know about the performance criteria is.

TEST PREPARATION:-
The initial step in testing must be the determination of what has to be measured. When
this decision is made, we can decide what type of test to use.

Selecting Appropriate Item Types:-

The items used in classroom tests are typically divided into two general categories:
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 The objective item, which is highly structured and requires the pupils to supply a
word or two or to select the correct answer from a number of alternatives, and
 The essay questions, which permit the pupils to select, organize, and present the
answer in essay form.

Each type should be used where most appropriate, with appropriateness determined by the
learning outcomes to be measured and by the advantages and limitations of each item type.

TYPES OF ACHIEVEMENT TEST:-

Test items can be usefully classified into three main categories:-

Classification of achievement tests

Teacher made Standardized tests

Essay type Short answer type Objective type

Classification of Objective type achievement tests

Recognition type Recall type

(1) (2) (3) (4) Single recall Completion

Alternative Response Multipurpose choice Matching Classification

ESSAY TYPE QUESTIONS:-

Introduction:-
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The essay type refers to any written test that require an examination to write a sentence, a paragraph
or longer passages and that demands a subjective judgment, about its quality and completeness when
it is scored. The essay type test is more familiar and widely used.

Definition:-
 An essay test presents one or more questions or other tasks that require extended written
responses from the person being tested.

- Robert Lebel and David A Frishie, 1986

 Essay item is an item that requires the student to structure a rather long written response up
to several paragraphs.
- William Wiersma and Stephen G Jurs 1990 ,

 Essay test is a test containing questions requiring the student to respond in writing. Easy test
emphasizes recall rather than recognition of the correct alternative. Easy tests may require
relatively brief responses or expanded responses. Sax
-Gilbert.

Classification of Eassy Questions:-

Essay type question

Extended response Restricted

Extended Response:-
 In extended response, no restriction is placed on the student as to the points he or she will
discuss and the organization of student will use. The student may select those points that
he/she thinks more important, pertinent and relevant to his/ her argument and the student may
organize the material in whichever way he wishes.
 .These are responses to essay questions in which the examinee is only restricted by time as
no bound is placed as regards the depth, breadth and the organization of the response. In
response
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to such a question the examinee demonstrates his ability to select and recall the facts which
he thinks are pertinent, organize and present his ideas in a logical and coherent form.
 This freedom to decide which facts he thinks is most pertinent to select his own method of
organization and to write as much as seems necessary for a comprehensive answer tends to
reveal the ability to evaluate ideas, relate them, coherently and to express them succinctly. In
addition, they expose the individual differences in attitudes, values and creative ability.
 This type of essay item is mostly useful in measuring learning outcomes at the higher
cognitive levels of educational objectives such as analysis, synthesis and evaluation levels.

Limitations of extended response:-

 They are insufficient for measuring knowledge of factual materials because they call for
extensive details in selected content areas at a time.
 Scoring such responses is usually difficult and unreliable since the examinees have free will
in the array of factual information of varying degree of correctness, coherence and
expression. These limitations are minimized in the Restricted Response Type.
For example: You are caring for a child diagnosed recently with HIV who lives with his
parents and two teenage sisters. Describe how to plan a care of child with HIV positive
status. Write an essay on care of child with HIV
An extended response type of essay questions permits the student to demonstrate their ability
to:
 Recall factual knowledge.
 Evaluate their factual knowledge.
 Organize their ideas.
 Present their ideas in a logical, coherent fashion.

Restricted Response:-

 In restricted response, the student is more limited or restricted in or as to form and scope
of his/her answer, because the student is specifically told the context in which his or her
answer is to be made. In this type, the questions are so structured that the students are
limited, the scope of the response is defined and restricted. The answers given are to
some extent controlled.

 In this type the examinee is limited to the nature, length or organization of response to be
made. The items are directional questions and are aimed at the desired responses. This
limits the examinee freedom to select, recall, and synthesize all that he knows and to
present them logically as he may wish. This type of essay item is most useful in
measuring learning outcomes at the lower cognitive levels of educational objectives, that
is, knowledge, comprehension and application levels.
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 The restricted nature of the expected response in this type of items makes it more
efficient for measuring knowledge of factual material. It reduces to a reasonable extent
the difficulty of scoring and encourages more reliability in scoring. However, the
restriction makes it less effective as a measure of ability to select, organize and integrate
ideas and present them in an original and coherent form which is one of the major
advantages of essay test.

For example:

 Describe five path physiological changes associated with the diabetes mellitus.
 Compare the metabolic and respiratory acidosis. Include the following in your response:
definition, precipitating factors, clinical manifestation, diagnostic tests and interventions.

A restricted response question will permit the students in:

 Problem solving exercises; focus on solving a problem and decision making processes. In
nursing contexts, clinical data are presented and the learner must demonstrate their ability
to access, analyze, plan, implement and evaluate.

OTHER ESSAY TYPE QUESTIONS:-

1. Interpretive essay--
In interpretative essay, Students are often given some form of data (eg. Scenario, graph,
table, picture) and are asked to apply the knowledge they have gained in the unit to interpret the
information given. The Student needs to write about both the knowledge he have and the way it
applies to this information

Example: As in IELTS reading passages

2. Hypothesis-formation essay--
In this case, the student has to relevant facts and come up with a consider hypothesis the
likely planning objections. This essay can written requires higher-order synthesis. memorized

Example: Imagine that you are the chairman committee charged with making for the sitting
of a new in a quiet suburban area recommendation for the setting of a new home for brain-injury
patient in a quiet suburban area of town. Speculate on planning objection to your proposal.

3. Questioning-assumptions essay –
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The assessment requires the student to explore the article thoroughly and to search
for the assumptions. These assumptions may not be obvious and the student may have to
analyse text deeply before they become apparent.
Example: Read the article from the journal research and comment on the author's
underlying assumption
4. Inquiry-based assessment—
As the name suggests, this type of assessment requires the student to undertake
some form of inquiry, the result of which must be written up in the form of a report.
Example: Carry out an investigation into working of Indian Nursing Council.
Write up your findings in the form of a report on working of INC.

Rules for Constructing Essay Items:-

1. Define the behavior the student is expected to exhibit before writing the prompt.
2. Ask the student to use the knowledge in novel situations rather than simply recalling
information.
3. Ask questions that are relatively specific and focused and which will elicit relatively
brief responses.
4. If you are using many essay questions in a test, ensure reasonable coverage of the course
objectives.
5. Follow the test specifications in writing prompts Questions should cover the subject
areas as well as the complexity of behaviors cited in the best blueprint. Pitch the
questions at the students level.
6. Formulate questions that present a clear task to be performed.
7. Provide ample time for answering and suggest a time limit for each question
8. Indicate the point value for each question
9. Word questions calling for an examinee opinion on controversial matters so that they ask
the examinee to give evidence to s support the opinion and evaluate the examinee's
response in terms of the evaluate presented rather than the opinion or position taken.
10. Require all examinees to answer the same questions, don't give optional questions.

Guidelines for Constructing Essay Type Questions:-

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Students should have a clear idea of what they are expected to do after they have read the
problem presented in an essay item. Below are specific guidelines that can help to improve
existing essay questions and create new ones: -

1. Clearly define the intended learning outcome to be assessed by the item:

The intended learning outcome is crucial for designing essay questions. If the outcome to be
assessed is not clear, it is likely that the question will assess for some skill, ability, or trait other
than the one intended.

In specifying the intended learning outcome teachers clarify the performance that students
should be able to demonstrate as a result of what they have learned. The intended learning
outcome typically begins with a directive verb and describes the observable behaviour, action or
outcome that students should demonstrate. The focus is on what students should be able to do
and not on the learning or teaching process. Reviewing a list of directive verbs can help to clarify
what ability students should demonstrate and to clearly define the intended learning outcome to
be assessed.

2. Avoid using essay questions for intended learning outcomes that are better assessed with
other kinds of assessment:

Some types of learning outcomes can be more efficient and more reliably assessed with
selected- response questions than with essay questions. In addition, some complex learning
outcomes can be more directly assessed with performance assessment than with essay questions.
Since essay questions, sample a limited range of subject-matter content, are more time
consuming to score, and involve greater subjectivity in scoring, the use of essay questions should
be reserved for learning outcomes that cannot be better assessed by some other means.

3. Define the task and shape the problem situation:

Essay questions have two variable elements:

 The degree to which the task is structured versus unstructured and

 The degree to which the scope of the context is focused or unfocused.

Although it is true that essay questions should always provide students with structure and focus
for their responses, it is not necessarily true that more structure and more focus are better than
less structure and less focus. When using more structure in essay questions, teachers are trying to
avoid at least two problems. The more structure helps to avoid the problem of student responses
containing ideas that were not meant to be assessed and the problem of extreme subjectivity
when scoring responses. Although more structure helps to avoid these problems, how much and
what kind of structure and focus to provide is dependent on the intended learning outcome that is
to be assessed by the essay question and the purpose for which the essay question is to be used.

Example:
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 Less-focused essay question

Evaluate the impact of technology on health of people.
 More-focused essay question
Evaluate the impact of the technology on health of students.
4. Helpful Instructions: Specify the relative point value and the approximate time limit in
clear directions:
Specifying the relative point value and the approximate time limit helps students allocate
their time in answering several essay questions because the directions clarify the relative
merit of each essay question. Without such guidelines, students may feel at a loss as to
how much time to spend on a question. When deciding the guidelines for how much time
should be spent on a question keep the slower students and students with certain
disabilities in mind. Also make sure that students can be realistically expected to provide
an adequate answer in the given and/or the suggested time.
5. Helpful Guidance: State the criteria for grading.
Students should know what criteria will be applied to grade their responses. As long as the
criteria are the same for the grading of the different essay questions, they don't have to be
repeated for each essay question but can rather be stated once for all essay questions. As for
example, all of your responses to essay questions will be graded based on the following
criteria:
The content of your answer will be evaluated in terms of the accuracy, completeness and
relevance of the ideas expressed. The form of your answer will be evaluated in terms of
clarity correct mechanics (spelling. punctuation, gram- mar, capitalization) and legibility.
6. Avoid the use of optional questions.
Students should not be permitted to choose one essay type question to answer from two or more
optional questions. The use of optional questions should be avoided for the following reasons:

 Students may waste time deciding on an option.

 Some questions are likely to be harder, which could make the comparative assessment of
students' abilities unfair.
 The use of optional questions makes it difficult to evaluate if all students are equally
knowledgeable about topics covered in the test.
7. Improve the essay question through, preview and review.
It can help to improve the essay item before and L after it is handed out to students. Preview
(before handing out the essay question to the students).

a. Predict student responses. Try to respond to the question from the perspective of a
typical student. Evaluate whether students have the content knowledge and the skills
necessary to adequately respond to the question. In detecting possible weaknesses of the
essay question, repair them before handing out the exam.
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b. Write a model answer. Before using a question, write model answer(s) or at least an
outline of major points that should be included in an answer. Writing the model answer
allows reflection on the clarity of the essay question. Furthermore, the model answer(s)
serve as a basis for the grading of student responses. Once the model answer has been
written compare its alignment with the essay question and the intended learning outcome
and make changes as needed to assure that the intended learning outcome, the essay
question, and the model answer are aligned with each other.
c. Ask a knowledgeable colleague to critically review the essay question, the model
answer, and the intended learning outcome for alignment.
Before using the essay question on a test, ask a person knowledgeable in the
subject (colleague, teaching assistant, etc.) to critically review the essay question, the
model answer, and the intended learning outcome to determine how well they are aligned
with each other. Based on the intended learning outcome, revise the question as needed.
By having someone else look at the test; the likelihood of creating effective test items is
increased, simply because two minds are usually better than one.
d. Review student responses to the essay question.
After students complete the essay questions, carefully review the range of answers given
and the manner in which students seem to have interpreted the question. Make revisions
based on the findings. Writing good essay questions is a process that requires time and
practice. Carefully studying the student responses can help to evaluate students'
understanding of the question as well as the effectiveness of the question.

Uses of Essay Type Questions:-

 To assess students' understanding of subject-matter content
 To assess higher-order thinking skills that cannot be adequately assessed by objectively
scored test items.
 To assess students' ability to construct rather than to select answers.
 When a teacher has sufficient resources and/or help (time, teaching assistants) to score
the student responses to the essay question(s).
 When the group to be tested is small.
 When a teacher is more confident of his/her ability as a critical and fair reader than as an
imaginative writer of good objective test items.
 Instructions of what to do should be clear, unambiguous and precise.
 Essay questions should be in layers. The first layer tests the concept, fact, its definition
and characteristics. The second layer tests the interpretation of and inferences from the
concept, fact or topic, concept, structure, etc. to real life situation. In the third layer, you
may be required to construct, consolidate, design, or produce your own structure,
concept, fact, scenario or issue.
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 Essays should not merely require registration of facts learnt in the class. They should not
also be satisfied with only the examples given in class.
 Some of the words that can be used in an essay type of test are: compare and contrast,
criticize, critically examine, discuss, describe, outline, enumerate, define, state, relate,
illustrate, explain, summarize, construct, produce, design, etc. Remember, some of the
words are mere words that require regurgitation of facts, while others require application
of facts.

Points to Remember When Constructing Essay Type Questions:-

 Make the essay items reflect course objectives.
 Include specific directions such as compare, contrast, define, discuss, formulate, etc.
 Prepare students for the test and provide essay test taking tips such as 'outline before
writing, plan ahead', and 'manage your time wisely
 For controversial topics, indicate clearly that the student should logically present a
position rather than take a specific stand.
 Limit the scope of the question.
 Have each student answer all the questions
 State the number of points each question is worth.

Advantages of Essay Type Questions:-

 The main advantage of the essay question is that it measures complex learning
outcomes that cannot be measured by other means.
 It emphasis on integration and application of thinking and problem solving skills
 It is relatively easier to prepare and administer a six question extended response
essay test than then to prepare and administer a comparable 60 multiple choice test
items.
 It is the only mean that can assess an examinee's ability, organize and present his
ideas in a logical and coherent fashion.
 In this type, abilities, logical thinking, critical reasoning and systematic presentation,
etc. can be best evaluated.
 It takes relatively lesser time to mark an essay type test.
 It can be used as an instrument for measuring and improving expression skills in the
language of the examinees.
 They are more helpful in valuating quality of the teaching process.
 It provides less scope for the use of unfair means. A Student can have free to
communicate, the ability for independent thinking.
 Essay type questions makes students free to communicate their ability for
independent thinking.
 Essay type questions test the ability of the student to communicate in writing depth
of knowledge and understanding.
 22

Disadvantages of Essay Type Questions:-

1. They possess relative low validity and reliability because of the following factors:
 Limited content sampling
 Subjectivity of scoring
 Contaminated by extraneous factors like spelling, good handwriting, colored inks,
neatness, grammar, lengths of answer
 Halo effect-biased judgment by previous impressions.
2. Essay questions are not given complete marks as objective type
3. They are time consuming-both for the examiner and the examinee
4. Sometimes the mood of examiner also influences marking.

SHORT ANSWER TYPE QUESTIONS

Definition:-

Short answer items require the examinee to respond to the item with a word, short phrase,
number or a symbol

- (Anthony J. Nitko)

A short answer test items aim to test the knowledge by asking student to supply a word, phrase
or a number that answer a question of complete a sentence.

-(R Eble et al, 1986)

Forms of Short Answer Questions:-

1. Question form
2. Identification or association form
3. Completion form

1. Question form:
Here the item is presented as direct question, e.g. who is the founder of Modern Nursing?

2. Completion form:
 23

Here an incomplete statement is used, e.g. sphygmomanometer is used to measure

3. Association form:
Here a few items are given outside the bracket. Students are expected to write the exact
related response in bracket. E.g. write the name of common instrument used which measure the
following temperature (............), blood pressure (............), heart rate ( )

Advantages of Short Questions:-

1. Short answer test is easy to construct as they measure only simple learning outcomes.
2. They are very useful for the recall of simple memorized facts and figures. It provides
little opportunity for guessing as the student is required to supply information or to solve
the numerical problems.
3. They are useful to the lowest level of cognitive taxonomy, i.e. classification etc.
knowledge of terminology,
4. A relatively large sample of the content can be covered by the inclusion of a large
number of short answer questions.
5. It is useful in evaluating the ability to interpret diagrams, chart and graphs.
6. Marking is relatively objective as compared with essay type questions.
7. There is little scope for the influence of handwriting and spelling etc. on marking.
8. Easy to construct.

Disadvantages of Short Answer Questions:-

1. They are not suitable for judging the power of analyzing and reasoning of the student.
2. They are not suitable for measuring complex learning outcomes.
Basic Principles for Constructing Short Answer Tests:-
i. Some of the principles for constructing multiple choice tests are relevant to constructing
short- answer tests.
ii. The instructions must be clear and unambiguous. Candidates should know what to
do. iii.Enough space must be provided for filing in the gaps or writing short answers.
iv. As much as possible the questions must be set to elicit only short answers. Do not construct
long answer-question in a short answer test.
v. The test format must be consistent. Do not require fill in gaps and matching in the same
question.
vi. The questions should be related to what is taught, what is to be taught or what to be examined.
Candidates must know beforehand the requirements and demands of the test.

Suggestions for Construction of Short Answer Questions:-

 24

The short -answer item is subject to a variety of defects, even though it is considered one of the
easiest to construct. The following suggestions will help in better construction of short answer
questions:

 Word the item so that the required answer is both brief and specific
 The question should not be picked up exactly from the book.
 The question should not provide any clue.
 A direct question is generally more desirable than an incomplete statement.
 If the answer is to be expressed in numerical units, indicate the type of answer wanted.
 Blanks for answers should be equal in length and in a column to the right of the question.
 If the answer is to be expressed in numerical units, indicate the type of answers wanted.
 The scoring key should be prepared.
 The blank space is to be completed with an important word rather than travail words.

MULTIPLE CHOICE TYPE QUESTION:-

Introduction:-
A multiple choice item consists of a problem and a list suggested solutions. The problem may
be stated as a direct question or an incomplete statement and is called of the items. The test may
include words, number, phrases or symbols and are called alternatives (also called choice or
options). The student is typically requested to read the stem and list of alternatives and to select
the one correct/best alternative

Anatomy of a Multiple Choice Item:-

A standard multiple choice test item consists of two basic parts, a problem (stem) and a list
of suggested solutions (alternatives). The stem may be in the form of either a question or an
incomplete statement, and the list of alternatives contains one correct or best alternative
(answer) and a number of incorrect or inferior alternatives (distracters).

All incorrect and less appropriate alternatives are called as 'distracters and the student task is
to select the correct or best alternative called as 'key' While constructing multiple choice type
test items. there should be at least three options, to reduce the chance of guessing.

Components and characteristics of good questions (Multiple

Choice form):-

The Stem
 25

 Should be in the form of a question or of a statement to be completed

 Should be expressed clearly and concisely, avoiding poor grammar, complex
syntax, ambiguity and double negatives
 Should generally present a positive question. (If a negative is used it should
be emphasized with italics or underlining.)
 Should generally ask for one answer only (the correct or the best answer)
 Should include as many as possible of the words common to all alternatives.

The Alternatives
 Each item should have either four or five alternatives, all of which should be
mutually exclusive and not too long.
 All alternatives should follow grammatically from the stem and be parallel in
grammatical form.
 the alternatives should be expressed simply enough to make clear the
essential differences between them, and must be unambiguous

For example, (Stem) The most heat sensitive vaccine is: Options:
(Distracter)

a. BCG
b. MMR
c. OPV
d. TT
1) Single Correct Answer Form:-

Single correct answer in items of the single-correct- answer variety, all but one of the
alternatives is incorrect; the remaining alternative is the correct answer. The student is directed to
identify the correct answer.

Example: For administration of an intramuscular injection to a 4 month old infant. The nurse
should select

 Dorsal gluteal site

 Rectus site
 Vastus lateralis
 Ventrogluteal site
2) Best Answer Form

In items of the best-answer variety, the alternatives differ in their degree of correctness.
Some may be completely incorrect and some correct, but one is clearly more correct than the
 26

others. This best alternative serves as the answer, while the other alternatives function as
distracters. The student is directed to identify the best answer.

Example: A manifestation of Chlamydial infection in the neonate is

 Eye discharge
 Nasal duct obstruction
 Umbilical cord inflammation.

Multiple Response Form

In items of multiple response variety, two or more of the alternatives are keyed as correct
answers; the remaining alternatives serve as distracters. The student is directed to identify each
correct answer.

Combined Response Form

In items of the combined-response variety, one or more of the alternatives are correct
answers; the remaining alternatives serve as distracters. The student is directed to identify the
correct answer or answers by selecting one of a set of letters, each of which represent a
combination of alternatives.

Example: Which of the following would indicate occurrence of cardiac arrest?

 Apnoea
 Absence of pulse
 Chest pain
 Dilated pupils

Example: Which of the following must be recorded on a patient's clinical record?

 Date of birth
 Gender

Insurance carrier:

 1, 2 and 3
 1 and 2 only
 2 and 3 only D, 3 only

Multiple True-False

 T F allergic reactions.
 27

 T F congestive heart failure.

 T F extensive burns.
 T F protein deficiency.

Negative

In items of the negative variety, the student is directed to identify either the alternative that is
an incorrect answer, or the alternative that is the worst answer. Any of the other multiple-choice
varieties can be converted into this negative format. Active immunization is available against all
of the following diseases EXCEPT:

 Malaria
 Poliomyelitis
 Smallpox
 Tuberculosis
 Yellow fever

Rules for Writing Multiple Choice

1. Use of Mausible Distracters (wrong-response options).

 Only list plausible distracters, even if the number of options per question changes
 Write the options so they are homogeneous in content
 Use answers given in previous open-ended exams to provide realistic distracters.
2. Use a Question Format.
 Experts encourage multiple-choice items to be prepared as questions (rather
than incomplete statements)
a) Incomplete Statement Format:
The capital of India is in ← (Less Effective)
b) Direct Question Format: -
In which of the following cities is the capital of India (More Effective)
3. Emphasize Higher-Level Thinking
 Use memory-plus application questions. These questions require students to
recall principles, rules or facts in a real life context.
 The key to preparing memory-plus application questions is to place the concept in a
life situation or context that requires the student to first recall the facts and then apply
or transfer the application of those facts into a situation.
 Seek support from others who have experience writing higher-level of thinking multiple-
choice questions. Examples:
a) Memory Only
 28

Which description best characterizes whole foods? (Less Effective)

 Orange juice
 Toast
 Bran celeal
 Grapefruit
b) Memory-Phis Application
Panama breakfast this morning included one glass of orange price (from concentrate pre
slice of trust, a small best of bran cereal and a grapefruit. What whole food did Poonam
eat for breakfast? More Effective
 Orange juice
 Toast
 Bran celeal
 Grapefruit
4. Keep Option Lengths Similar
 Avoid making your correct answer the long or short answer.
5. Balance the Placement of the Correct Answer
 Correct answers are usually the second and third option.
6. Be Grammatically Correct
 Use simple, precise and unambiguous wording
 Students will be more likely to select the correct answer by finding the grammatically
correct option.
7. Avoid Clues to the Correct Answer.
 Avoid answering one question in the test by giving the answer somewhere else in the test.
 Have the test reviewed by someone who can find mistakes, clues, and grammar and
punctuation problems before you administer the exam to students.
 Avoid extremes-never, always, only
 Avoid nonsense words and unreasonable statements.
8. Give Clear Instructions:
Such as:

Questions 1-10 are multiple choice questions designed to assess your ability to remember or
recall basic and foundational pieces of knowledge related to this course. Please read each
question carefully before reading the answer options. When you have a clear idea of the
question, find your answer and mark your selection on the answer sheet. Please do not make any
marks on this exam.

Questions 11-20 are multiple-choice questions designed to assess your ability to think critically
about the subject. Please read each question carefully before reading the answer options. Be
aware that some questions may seem to have more than one right answer, but you are to look for
 29

the one that makes the most sense and is the most correct. When you have a clear idea of the
question, find your answer and mark your selection on the answer sheet. You may justify any
answer you choose by writing your justification on the blank paper provided.

9. Avoid the 'All the Above' Option:-

 Students merely need to recognize two correct options to get the answer correct

10. Avoid the 'None of the Above' Option.

 You will never know if students know the correct answer.

11. Avoid Negative Questions.

 31 of 35 testing experts recommend avoiding negative question.
 Students may be able to find an incorrect answer without knowing the correct answer.
12. Use Only One Correct Option (Or be sure the best option is clearly the best
option).
 The item should include one and only one correct or clearly best answer.
 With one correct answer, alternatives should be mutually exclusive and not overlapping.
 Using MC with questions containing more than one right answer lowers discrimination
between students.
13. Don't Use MC Questions When Other Item Types Are More Appropriate.
 Limited distracters or assessing problem- solving and creativity.
14. Use Only a Single, Clearly-Defined Problem and Include the Main Idea in the
Question.
 Students must know what the problem is without having to read the response options.

Merits of Multiple Choice Questions:-

1. They can measure from the most elementary knowledge level to the most complex
level, understanding and judgment and ability to solve the problems.
2. They can be scored entirely objectively, quickly and accurately by machines, clerks and
even students themselves.
3. These can be written in several forms which provide opportunities for measuring.
4. They reduce the effect of guessing because there are three or four choices.
5. They are objective in scoring because the key of the correct answer is prepared along
with the test.
 30

Limitations of Multiple Choice Questions:-

1. They are difficult to construct. The teacher cannot always think of plausible distracters.
2. More time required to construct such items.
3. It is difficult to find four choices for each item.
4. They do not permit the examinee to express their own views
5. They cannot measure attitude and motor skills.
6. An element of guess work is not entirely eliminated.

Advantages of Multiple Choice Items:-

1. Versatility: Multiple-choice best items are appropriate for use in many different subject
matters areas, and can be used to measure a great variety of educational objectives. They
are adaptable to various levels of learning outcomes, from simple recall of knowledge to
more complex levels, such as the student's ability to:
 Analyze phenomena
 Apply principles to new situations
 Comprehend concepts and principles
 Discriminate between fact and opinion
 Interpret cause-and-effect relationships
 Interpret charts and graphs
 Judge the relevance of information
 Make inferences from given data
 Solve problems
2. Validity: In general, it takes much longer to respond to an essay test question than it does to
respond to a multiple-choice test item, since the composing and recording of an essay answer
is such a slow process. A student is therefore able to answer many multiple-choice items in
the time it would take to answer a single essay question. This feature enables the teacher
using multiple-choice items to test a broader sample of course content in a given amount of
testing time. Consequently, the test scores will likely be more representative of the students'
overall achievement in the course.
3. Reliability: Well-written multiple-choice test items compare favourably with other test
item types on the issue of reliability. They are less susceptible to guessing than are true
false test items, and therefore capable of producing more reliable scores. Their scoring is
more clear-cut than short-answer test item scoring because there are no misspelled or partial
answers to deal with. Since multiple-choice items are objectively scored, they are not
affected by scorer inconsistencies as are essay questions and they are essentially immune to
the influence of bluffing and writing ability factors, both of which lower the reliability of
essay test scores.
 31

4. Efficiency: Multiple-choice items are amenable to rapid scoring, which is often done
by scoring machines. This expedites the reporting of test results to the student so that any
follow-up clarification of instruction may be done before the course has proceeded much
further Essay questions, on the other hand, must be graded manually, one at a time.

Rules for True-False Items:-

 Include only one central significant idea in each statement so precisely that it can
be judged
 Word the statement unequivocally true or false
 Use negative statements sparingly and avoid double negatives
 Statements of opinion should be attributed to some source
 Keep statements short and use simple language structure.

Guidelines for Constructing Multiple Choice tems

The following guidelines will help in constructing better multiple choice test items. These
guidelines are specifically designed for the single-answer and best answer varieties of multiple-
choice items:

1. Construct each item to assess a single written objective: Items that are not written with
a specific objective in mind often end up measuring lower level objectives exclusively, or
covering trivial material that is of little educational worth.
2. Base each item on a specific problem stated clearly in the stem: The stem is the
foundation of the item After reading the stem, the student should know exactly what the
problem is and what he or she is expected to do to solve it. If the student has to infer
what the problem is, the item will likely measure the student's ability to draw inferences
from vague descriptions rather than his or her achievement of a course objective.
3. Include as much of the item as possible in the stem, but do not include irrelevant
material: Rather than repeating redundant words or phrases in each of the
alternatives, place such material in the stem to decrease the reading burden and more
clearly define the problem in the stem.
4. State the stem in positive form (in general): Negatively-worded items are those, in
which the student is instructed to identify the exception, the incorrect answer, or the
least correct answer. Such items are frequently used, because they are relatively easy to
construct. The teacher writing the item need only come up with one distracter rather than
the two to four required for a positively worded item. Positive items, however, are more
appropriate to use for measuring the attainment of most educational objectives.
5. Word the alternatives clearly and concisely: Clear wording reduces student confusion,
and concise wording reduces the reading burden placed on the student
 32

6. Keep the alternatives mutually exclusive: Alternatives that overlap create undesirable
situations. Some of the overlapping alternatives may be easily identified as distracters.
On the other hand, if the overlap includes the intended answer, there may be more than
one alternative that can be successfully defended as being the answer.
7. Keep the alternatives homogeneous in content: If the alternatives consist of a potpourri
of statements related to the stem but unrelated to each other, the student's task becomes
unnecessarily confusing. Alternatives that are parallel in content help the item present a
clear-cut problem more capable of measuring the attainment of a specific objective.
8. Keep the alternatives free from clues as to which response is correct: Poorly-written
items often contain clues that help students who do not know the correct answer
eliminate incorrect alternatives and increase their chance of guessing correctly. Such
items tend to measure how clever the students are at finding the clues rather than how
well they have attained the objective being measured. The following suggestions will
help you detect and remove many of these clues from your items.
i. Keep the grammar of each alternative consistent with the stem . Students often
assume that inconsistent grammar is the sign of a distracter, and they are
generally right.
ii. Keep the alternatives parallel in form. If the answer is worded in a certain way and
the distracters are worded differently, the student may take notice and respond
accordingly.
iii. Keep the alternatives similar in length. An alternative noticeably longer or
shorter than the other is frequently assumed to be the answer, and not without good
reason.
iv. Avoid textbook, verbatim phrasing. If the answer has been lifted word-for-word from
the pages of the textbook, the students may recognize the phrasing and choose
correctly out of familiarity rather than achievement.
v. Avoid the use of specific determiners. When words such as never, always, and only
are included in distracters in order to make them false, they serve as flags to the alert
student.
vi. Avoid including keywords in the alternatives When a word or phrase in the stem is
also found in one of the alternatives, it tips the student off that the alternative is
probably the answer.
vii. Use plausible distracters. For the student who does not possess the ability being
measured by the item, the distracters should look as plausible as the answer.
Unrealistic or humorous distracters are non-functional and increase the student's
chance of guessing the correct answer.
9. Avoid the alternatives all of the above' and 'none of the above (in general): These
two alternatives are frequently used when the teacher writing the item has trouble coming
up with a sufficient number of distracters. Such teachers emphasize quantity of
distracters over quality
 33

10. Use as many functional distracters as are feasible: Functional distracters are those
chosen by students that have not achieved the objective and are ignored by students
that have achieved the objective. In other words, they have positive discrimination.
11. Include one and only one correct or clearly best answer in each item: When more
than one of the alternatives can be successfully defended as being the answer,
responding to an item becomes a frustrating game of determining what the teacher had in
mind when he or she wrote the item. Such ambiguity is particularly a problem with items
of the best answer variety, where more than one alternative may be correct, but only one
alternative should be clearly best. If competent authorities cannot agree on which
alternative is clearly best, the item should either be revised or discarded.
12. Present the answer in each of the alternative positions approximately an equal
number of times, in a random order. Many teachers have a tendency to avoid placing
the answer in the first or last alternative positions, preferring instead to 'bury the answer
in the middle.' This tendency, however, is not unknown to certain students, who
generally select one of the alternatives in the middle if they are unsure of the answer.
Also, if there is a noticeable pattern to the positions of the answers from item to item,
alert students will take notice and make their selections accordingly. In either case, the
unprepared but clever student increases his or her chance of obtaining a higher score. The
easiest method of randomizing the answer position is to arrange the alternatives in some
logical order.
The following table gives examples of three logical orders. The best order to use for a
particular item depends on the nature of the item's alternatives.
13. Lay out the items in a clear and consistent manner: Well-formatted test items not only
make taking the test less confusing and less time consuming for students, they also make
grading the test easier, especially when the grading is done by hand. The following
suggestions may help to improve the layout of your items.
 Provide clear directions at the beginning of each section of the test
 Use a vertical format for presenting alternatives.
 Avoid changing pages in the middle of an item.

14. Proper use of grammar, punctuation, and spelling: Adherence to it reduces ambiguity
in the item and encourages students to take your test more seriously.
15. Avoid using unnecessarily difficult vocabulary: If the vocabulary is somewhat
difficult, the item will likely measure reading ability in addition to the achievement of
the objective for which the item was written. As a result, poor readers who have achieved
the objective may receive scores indicating that they have not. Use difficult and technical
vocabulary only when essential for measuring the objective.
16. Analyze the effectiveness of each item after each administration of the test. Item
analysis is an excellent way to periodically check the effectiveness of your test items.
It
 34

identifies items that are not functioning well, thus enabling you to revise the items,
removes them from test, or revises instruction, whichever is appropriate.

TRIPURA INTITUTE OF PARAMEDICAL SCIENCES, NURSING

ST
ANM 1 YRAR TREM II EXAMINATION

SUBJECT- COMMUNITY HEALTH NURSING

Objective type Question:-

 35

Time – 20 minutes
Marks-15

Question No -1
Match the column – A with column – B 0.5 x 10=05

Column – A Column– B
a) World health day i) Indigenous system of medicine
b) Family ii) 30000 population
c) AYUSH iii) 3- tier system
d) Determinations of health iv) Tuberculosis
e) COVID-19 v) Community Health Nursing
f) Primary Health Centre vi) National He4alth Programme
g) Pulse Polio vii) Problem Solving Approach
h) Panchayat raj viii) 7th April
i) DOTS ix) basic unit of society
j) Counseling x) physical / social environment
Xi) Infectious Disease

Question No – 2
Write TRUE and FALSE against following statement 0.5 x 10 = 05
a) Miss Florence nightingale was born on 12th June 1970.
b) Data collection is the method of survey.
c) An ASHA is expected to cover 2000 population in a village.
d) Communication is a continuous process.
e) Goitre is a deficiency disease of iron.
f) A good referral system is an essential component of health care system.
g) Follow up is the most important part of home visiting.
h) The term MMR means measles, mastoiditis, and rubella.
i) Flash card is purely auditory aid.
j) First referral unit is district hospital.

Question no -03
Put a tick(√) mark against the correct answer-
a) Which one is an airborne disease –
i. Malaria
ii. T.B
 36

iii. Cancer
iv. Fever
b) The head quarter of WHO is –
i. Italy
ii. London
iii. Geneva
iv. USA
c) BCG vaccine is given against –
i. Poliomyelitis
ii. T.B
iii. Measles
iv. Whooping cough
d) Record must be kept in –
i. carefully
ii. completely
iii. with lock and key
iv. all of the above
e) Which one is non-communicable disease-
i. Diphtheria
ii. Diarrhoea
iii. Hypertension
iv. malaria
f) Care of aged person means-
i. geriatric nursing
ii. mental health nursing
iii. community health nursing
iv. All of the above.
g) Communication means –
i. sharing information
ii. socialization
iii. over population
iv. Getting information.
h) Community health means-
i. health status of all team
ii. health status of community person
iii. health care provider of community
iv. Both (ii) and (iii)
i) Health problem can be prevented by –
i. proper immunization
ii. using of only medication
iii. proper health education and awareness
iv. Home visit only.
j) Night blindness is a deficiency disease of –
 37

i. vitamin-A
ii. vitamin-D
iii. vitamin-E
iv. vitamin-C

EASSY TYPE QUESTION:- ( any two )

Question no -4 2+2+1.5+1.5+3=10
a) Define health.
b) Define primary health care.
c) What are the dimensions is determinants of health?
d) Write about components of primary health care?
e) Describe about role of ANM in primary health care.

Question no – 5 2+3+(2+3)=10
a) What is Communication?
b) What are the types of Communication?
c) What are the main barriers of Communication and discuss process of communication?

Question no – 6 2+2+3+3=10
a) What do you mean by counseling?
b) Identify the need and areas of counseling in the community?
c) What are the functions of Sub centre?
d) Write about WHO.

Short Answer type Question { any three }

Question no – 7 5 x 3=15
a) Home visit.
b) Referral system.
c) Family.
d) Community survey.
e) Roles and responsibilities of ASHA.

CONCLUSION:-
A non-standardized test is one that allows for an assessment of an individual's abilities or
performances, but doesn't allow for a fair comparison of one student to another. This type of test
contrasts standardized tests, such as state educational development tests and college entrance
exams.
 38

BIBLIOGRAPHY:-
1. D.Elakkuvana Bhaskara raj, Nima Bhaskar.“TEXT BOOK OF NURSING
EDUCATION”. 2nd edition. EMMESS medical publisher. Page No-467 to 472.
 39

2. Sodhi J. k, Kaur S. “TEXT BOOK OF NURSING EDUCATION”. 1st edition 2017.

JAYPEE the health science publisher. Page No-201 to 218
3. Sudha R. “NURSING EDUCATION PRINCIPLES AND CONCEPT”. 1st edition 2013.
JAYPEE Brothers medical Publishers (P) LTD. Page no-163 to 171
4. Basher Shebeer p.”TEXT BOOK OF NURSING EDUCATION”, 2ND edition. Emmess
Medical Publisher, Page no-216- 226