A Composite Cognition Instrument for Nursing Care of Combat Casualties

Abstract

In the course of caring for military and civilian combat casualties, military nurses must make rapid, accurate decisions. When developing methods to teach nurses essential content for combat casualty care, it is important to understand the cognitive and learning processes involved in acquiring that knowledge. Measures to examine how military nurses think and learn have significance, especially when applied to the high-stress, high-stakes practice arena of combat causality care. Use of these measures in evaluating educational strategies will help answer the need for better deployment readiness for military nurses. The purpose of this study is to develop an instrument to measure a newly conceptualized construct, composite cognition, formulated to explain the cognitive and learning processes related to the care of combat casualties using specific conditions seen in combat, and to examine its psychometric properties to establish preliminary reliability and validity. The conceptual framework for this study was informed by the theoretical perspectives of Bloom's taxonomy, critical thinking theory, and the nursing process. Krathwohl's (2002) revised taxonomy was used while still retaining Bloom's more widely recognized original taxonomic terms/categories. These categories were combined to form the subscales of the Composite Cognition Instrument (CCI). The CCI measures the three subscales of cognition: lower-level cognition, higher-level cognition, and critical thinking cognition. Seventy-five multiple choice questions were developed based upon three combat trauma scenarios: hypovolemic shock, tension pneumothorax, and cardiac tamponade. The instrument was administered to 32 military nurses using a test-retest method to establish preliminary reliability and validity. Validity was supported through expert review; the congruency percentage was 100%; the item subscale/objective congruence was .8026. Test-test reliability was established with a Pearson r of .890; reliability was also statistically significant for the subscales. A Kuder-Richardson score (KR20) of .91 indicated text dependability. The mean item difficulty was .57 on the pre- and posttest. Point-biserial correlations and discrimination indexes demonstrated good item discrimination. Future testing is needed with a larger sample. This instrument adds to the body of knowledge for teaching combat casualty care and will be used to evaluate educational approaches for military nurses caring for injured soldiers and civilians in combat areas.