Hayes, Janice

Committee Member

Wilson, Vicki

Committee Member

Hummel, Faye L.

Committee Member

Rue, Lisa A.


Nursing Education


University of Northern Colorado

Type of Resources


Place of Publication

Greeley (Colo.)


University of Northern Colorado

Date Created





282 pages

Digital Origin

Born digital


This dissertation manuscript describes a research study to validate the disciplinespecific Fairness of Items Tool (FIT) for its use by nurse educators in identifying bias in multiple-choice questions (MCQs) to improve the quality of examinations. Multiplechoice (MC) examinations are a common assessment method used in programs of nursing, and conclusions based on these assessments have high stakes consequences. Faculty members therefore have an obligation to ensure that tests are valid and reliable assessments of student learning. For an examination to be a fair, valid, and reliable, it must contain well-written test items. Constructing and revising test items is difficult and time consuming, and nursing faculty members lack adequate preparation and sufficient time for examination construction and analysis. Published guidelines are available to assist faculty in creating examination items; however, assessments and textbook item banks contain violations of these guidelines, resulting in the administration of assessments containing flawed test items. Developing clear and concise guidelines for nursing faculty to use in developing unbiased test items is one strategy that may improve the quality of nursing assessments, thereby improving the quality of the decisions made based on these assessments. Development and validation of the FIT was a three-phase process grounded in two theoretical frameworks adapted for this research study: the Revised Framework for Quality Assessment and the Conceptual Model for Test Development. In the first phase, the tool was developed by the primary investigator through an extensive review of published higher education and nursing literature related to item-writing rules, examination bias, and cultural bias. This dissertation study comprised phases two and three, using systematic methods to establish the validity and reliability of the FIT. In phase two, content validity and face validity were established through review by a panel of item-writing experts. In phase three, multiple measures were used to establish reliability and construct validity through testing of the FIT by nursing faculty (N = 488) to evaluate sample MCQs. The results of this research study support the hypothesis that the FIT is a valid and reliable tool for identifying bias in MC examination items as one component of a systematic process for test development. Nurse educators can use the Fairness of Items Tool (FIT) as a guide for writing MCQs and revising textbook test bank items to improve the quality of examinations. The FIT also provides a means to facilitate systematic research to validate item-writing guidelines and testing procedures and to improve the quality of MC test items. Improving the quality of nursing examinations has the potential to improve student success and better prepare graduates for licensure and certification examinations, indirectly increasing the quality, quantity, and diversity of nurses joining the workforce.

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