Knowledge of Bloom’s Hierarchy of Cognitive Levels of Educational Objectives and its use in Setting Examinations by Nurse Educators in Lusaka and Eastern Provinces

Download Article

DOI: 10.21522/TIJNR.2015.03.02.Art008

Authors : Patricia Mambwe


Background: The use of Bloom’s hierarchy of cognitive levels of educational objectives as a tool for classroom assessments is rapidly increasing therefore, Nurse Educators’ knowledge of the tool is vital.

Objective: The first prime objective of this study was to investigate nurse educators’ knowledge of Bloom’s hierarchy of cognitive levels of educational objectives.

Materials and Methods: A cross sectional study was conducted in nursing training schools of Lusaka and Eastern provinces of Zambia. The study sample comprised of 63 Nurse Educators who were selected using purposive sampling method. A self-administered questionnaire was used to collect data from the respondents. Statistical Package for Social Sciences (SPSS) version 20 was used to analyse data. The Chi Square test was used to compare the proportions. A result yielding a P value of less than 5 percent was considered to be statistically significant.

Results: The findings were that 64% of nurse educators had low knowledge, 22% had moderate knowledge while 14% had high knowledge on Bloom’s hierarchy of cognitive levels of educational objectives. Results from the study indicated that 90% of nurse educators affirmed that Continuing Professional Development meetings on assessment techniques were not conducted in the schools of nursing while 10% indicated that they had them.

Conclusion: Though the nurse educators undergo training on Bloom’s taxonomy, their knowledge on this topic is low and calls for Continuous Professional Development Meetings. This will improve quality and standards of examinations in nursing education which will in turn improve the performance of nurses in the clinical area.

Keywords: Knowledge, use, Bloom’s hierarchy, cognitive levels, educational objectives, setting examinations, Nurse Educators


[1]. Affiliated Health Training Institutions (2004). Assessment standards for semesterised and non semesterised programs. Gaborone, Botswana.

[2]. Agbedia, C and Ogbe, J. (2014). Critical thinking; issues in nursing education and practice. International Journal of Advanced Nursing Studies, 3 (1) 13 – 17. accessed on 06/03/14 at 11: 14 hours.

[3]. Allen, L. (2008). The Nursing shortage continues as faculty shortage grows. Nursing Economics, 26 (1) 35 – 40. accessed on 9/3/14 at 09:30 hours.

[4]. American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Washington, DC. American Nurses Publishing Company. Accessed on 9/3/14 at 10:01 hours.

[5]. Anderson, L. W, David R. and Krathwohl, D. R., et al (Eds.). (2001). A Taxonomy for Learning, Teaching, and Assessing: A Revision of Bloom's Taxonomy of Educational Objectives. Allyn & Bacon. Boston, MA (Pearson Education Group). Http://’s taxonomy.htm accessed on 12/02/14 at 15 hours.

[6]. Athanassiou, N. McNett, J.M and Harvey, C. (2003). Critical thinking in the management classroom: Bloom’s Taxonomy as a learning tool. Journal of Management Education, 27(5) 533 – 55. accessed on 10/04/14 at 14:30 hours.

[7]. Ayvaci, H.S and Turkdogan, A. (2010). Analysing “Science and Technology Course exam questions” according to Revised Bloom’s Taxonomy. Turkish Science Education, 7 (1) 13 – 25. accessed on 28/01/14 at 14:50 hours.

[8]. Azer, S. A. (2006). Assessment in a problem based learning course: Twelve tips for constructing multiple choice questions that test student’s cognitive skills. Biochem.Mol.Biol.Educ., 31(6) 428 – 434. accessed on 14/03/14.

[9]. Bailey, L.R. (2011). Standardized procedure guidelines. Retrieved from accessed on 11/5/15 at 17:21 hours.

[10].  Bandaranayake, R. (2008). Setting and maintaining standards in multiple choice examinations. AMEE guide No. 37, medical teacher, 30 (9) 836 – 845. accessed on 9/3/14 at 11:30 hours.

[11].  Beekman, L. (2000). Problem solving and decision making strategies skills: A co – curriculum teaching thinking skills for nursing students. South Africa: Van Schaiki.

[12].  Blanchette, J. (2001). Journal of Distance Education. Royal Roads University, Victoria, BC. http://www.cade.athabascau.calvo116.2/blanchette.html. accessed on 9/3/14 at 16:05 hours.

[13].  Bloom, B. S. (1956). Taxonomy of Educational Objectives: The classification of educational objectives. New York. David McKay. accessed on 03/3/14 at 08:20 hours

[14].  Boikhutso, K. (2010). The theory into practice dilemma: lesson planning challenges facing Botswana student – teachers. accessed on 24/02/2014 at 20:54 hours.

[15].  Brady, A. M. (2005). Assessment of learning with multiple choice questions, 5 (4) 238 – 42. Journal for Nurse Education and Practice. accessed on 10/04/14 at 15:06 hours.

[16].  Bradley, M. et al (2007).Ask and you will receive: How question types influences quantity and quality of online discussions. British Journal of Educational Technology, 39, 888-900.

[17].  Brown, G. (2001). Assessment: A Guide for lecturers. accessed on 14/03/14 at 07: 55 hours.

[18].  Bumen, N. T. (2007). Effects of the original versus revised Bloom’s Taxonomy on lesson planning skills: a Turkish study among pre-service teachers. Review of Education, 53, 439 – 455.

[19].  Burns, N and Grove, S. K. (2009). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. 6th edition, Saunders Elsevier.

[20].  Clauss, J and Geedey, K. (2010). Knowledge Surveys: Students ability to self – assess, 10(2) 14 – 24. Journal of the scholarship of Teaching and Learning. on 21/04/14 at 06:30 hours.

[21].  Clifton, S and Schriner, C. (2010). Assessing the quality of multiple choice test items. Nurse educator, 35(1) 12 – 16. accessed on 9/3/14 at 15:05 hours.

[22].  Considine, J. Bott, M. and Thomas, S (2005). Design, format, validity and reliability of multiple choice questions for use in nursing research and education. Collegian, 12 (08) 19 – 24.,format,validity Accessed on 9/3/14 at 14 hours.

[23].  Cook, J. (2013). How can a teacher use Bloom’s taxonomy in the classroom? Retrieved June 26, 2014 at 19:49 hours from

[24].  De Young, S (2009). Teaching Strategies for Nurse Educators. 2nd edition, New Jersey: Prentice Hall.

[25].  Downing, S. (2005). The effects of violating standard item writing principles on tests and students: The consequences of using flawed test items on achievement examinations in medical education, 10 (2) 133 – 143. accessed on 9/3/14 at 17:10 hours.

[26].  Eber, P.A and Parker, T.S (2007). Assessing student learning: applying Bloom’s Taxonomy. Human Service Education, 27(1) 45 – 53. accessed on 13/03/14 at 20:08 hours.

[27].  Edwards, S (2003). Critical thinking at bedside: a practical perspective. British Journal of Nursing, 12(19) 1142-1149. http://www.britishjournalofnursing accessed on 9/3/2014 at 22:15 hours.

[28].  Ellis, K (1993). Teacher questioning behaviour and student learning: What research says to teachers? Paper presented at the 64th annual meeting of the Western States Communication Association, Albuquerque. accessed on 10/3.2014 at 20:31 hours.

[29].  Ferris, L.J. and Azizi, S.M. (2005). A psychomotor Skills Extension to Bloom's Taxonomy of Education Objectives for Engineering Education. University of South Australia, Mawson Lakes, 5095, Australia: Putney Publishing.

[30].  Fesler – Birch, D.M (2005). Critical thinking and practical outcomes. A review. Nursing outlook, 53(2) 59 – 65.

[31].  Garekwe, M (2010). Analysis of cognitive levels of examination questions set in the Bachelor of Nursing Programme at the University of KwaZulu-Natal. Masters dissertation in Nursing Education. accessed on 25/2/2014 at 20:49 hours.

[32].  General Nursing Council of Zambia (2005): The Nursing Regulatory Framework. Lusaka, Zambia.

[33].  Goodman, B (2011). The sociological imagination, provocative pedagogy and scholarship: re-valuing thinking and writing in nurse education. Nurse Education Today. accessed on 13/04/14 at 21: 26 hours.

[34].  Haladyna, T.M., Downing, S.M., and Rodriguez, M.C (2002). A review of multiple – choice item writing guidelines for classroom assessment. Applied measurement in education, 15(3) 309-334. Http:// accessed on 14/07/2014 at 09:13 hours.

[35].  Hard, J (2010). Creating tests that assess higher order thinking skills. accessed on 10/04/14 at 14:47 hours.

[36].  Jozefowicz, R. Koeppen, B. Case, S. Galbraith, R. Swanson, D. Glew, R (2002). The effects of violating standard item writing principles on tests and students: the consequences of using flawed test items on achievement examinations in medical education, 77(2) 156 – 161

[37].  Kantar, L. D (2013). Assessment and instruction to promote higher order thinking in nursing students. accessed on 31/03/14 at 14:44 hours.

[38].  Kastberg, S.E (2003). Using Bloom’s Taxonomy as a framework for classroom assessment. The mathematics teacher, 96(6) 402 – 405. accessed on 25/03/2014 at 16:11 hours.

[39].  Kim, S. Phillip, W.R. Pinsky, L. Brock, D. Phillips, K. and Keary, J (1996). A conceptual framework for developing teaching cases. A review and synthesis of the literature across disciplines. Journal of Medical Education, 40(9) 867 – 876. accessed on 09/03/14 at 01:14 hours.

[40].  Kim, M. Patel, R. Uchizono, J, Beck, L (2012). Incorporation of Bloom’s Taxonomy into multiple – choice examination questions for a pharmacotherapeutics course. American Journal of Pharmaceutical Education, 76(6) 14. accessed on 28/01/2014 at 15:16 hours.

[41].  Krejcie R. V., And Morgan D. W., (1970): Determining Sample Size for Research Activities. Educational and Psychological Measurement. Published formula for determining sample size. ... The relationship between sample size and total population illustrated in Figure 1. Accessed on 6/05/2014 from

[42].  Knapp, R. (2014). Continuing Nursing Competency. Http:// accessed on 14/03/14 at 13: 15 hours.

[43].  Krathwohl, D. R (2002). A revision of Bloom’s Taxonomy: An overview. Theory into practice, 41(4) 212 -218. accessed on 14/03/14 at 07:30 hours.

[44].  Krau, (2011). Creating educational objectives for patient education using the new Bloom’s Taxonomy, 46(3) 299 – 312. accessed on 14/03/14 at 14:50 hours.

[45].  Masters, J. Hulsmeyer, B. Pike, M. Leichty, K. Miller, M. and Verst, A (2001). Assessment of MCQ in selected test banks accompanying text books used in nursing education. Journal of nursing education, 40(1) 25 – 32. http://www.ncbi.nlm.nih/gov/pubmed/11198906. accessed on 10/3/14 at 08:00 hours.

[46].  Ministry of Health (2006 to 2011) National Health strategic Plan, Lusaka, Zambia.

[47].  Mkandawire, C. (2013). Teachers Questioning techniques in Mathematics at Grade 11 level: The case of four selected secondary schools in Petauke District. Masters dissertation in Education. University of Zambia.

[48].  Moreno.R., Martinez, R., and Muniz, J (2006). New guidelines for developing multiple – choice items. Methodology, 2(2) 65 – 72. accessed on 11/4/14 at 9:26 hours.

[49].  Morrison, S. and Walsh Free, K. (2001). Writing Multiple Choice test items that promote and measure critical thinking. Journal of Nursing Education, 40(1) 17-24. Accessed on 9/3/2014 at 19:30 hours.

[50].  Msidi. E.J., (2010): The General Nursing Council of Zambia: Registered Critical Care Nursing Curriculum. Zero Draft, Lusaka.

[51].  Mukarugwiza, F. (2003). Analysis of the cognitive level of basic nursing examinations in Rwanda. Durban, South Africa.

[52].  National League for Nursing. (2005). Core competencies of Nurse Educators. Retrieved from

[53].  Nicholl, M. and Tracey, C. (2007). Questioning: A tool in the nurse educators’ kit; 7, 285 – 295. Journal for Nurse Education in Practice. accessed on 20/09/2015 at 20:41 hours.

[54].  Nkonde (2014). Chilenje patient dies on the queue. accessed on 20/03/14 at 04:34 hours.

[55].  O’Neill, G. (2010). Overview of curriculum models program design. UCD Teaching and Learning Resources. accessed on 13/03/14 at 19:50 hours.

[56].  Palmer, E. and Devitt, P. (2007). Assessment of higher order cognitive skills in undergraduate education: modified essay or multiple choice questions? Research paper, medical education, 49 (7) 7 – 4. accessed on 03/03/14 at 09:30 hours.

[57].  Pardue, S.F. (1987). Decision – making skills and critical thinking ability amongst associate degree, diploma, baccalaureate and masters – prepared nurses. Journal of Nursing Education, 26 (9) 354 – 361. accessed on 13/03/14 at 18: 06 hours.

[58].  Phillips, N. and Duke, M. (2001). The questioning skills clinical teachers and preceptors: A comparative study. Journal of Advanced Nursing, 33 (4) 523 – 532. Available at academic search premier database. Accessed on 02/03/14.

[59].  Polit, D. F. and Beck, C. T. (2008). Generating and Assessing Evidence for Nursing Practice, 8th edition, Lippincott, Philadelphia.

[60].  Polit. D.F and Hungler. B. (2001): Nursing Research, Principles and methods,

[60].Lippincott, Philadelphia.

[61].  Profetto – Mcgrath, J. Smith, K. Day, R. and Yonge, O. (2008). The questioning skills of tutors and students in a context based baccalaureate nursing program. Nursing Education Today, 24(5) 363 – 372.

[62].  Reichert, T.G. (2011). Assessing The Use of High Quality Multiple Choice Exam Questions in Undergraduate Nursing Education: Are Educators Making the Grade? Masters of Arts in Nursing Thesis. St. Catherine University. accessed on 14/03/14 at 07:15 hours.

[63].  Russel, A. Comello, R. Wright, D (2007). Journal of Education and Human Development, 1(1) 1934 – 7200.

[64].  Scheffer, B and Rubenfeld, M (2000). A consensus statement on critical thinking in nursing. Journal of Nursing Education, 39(8) 352 – 60.

[65].  Sellappah, S. Hussey, T. Blackmore, A. and McMurray, a (1999). The use of questioning strategies by clinical teachers. Journal of Advanced Nursing, 28(1) 142 – 149. accessed on 13/03/14 at 19:43 hours.

[66].  Sithole, P. C. (2011). ‘An exploration of teaching strategies utilised in the facilitation of learning for first level students in general nursing science’. University of Pretoria, South Africa. accessed on 14/03/14 at 07:18 hours.

[67].  Tarrant, M. Knierim, A. Hayes and Ware, J (2006). The frequency of item writing flaws in multiple choice questions used in high stakes nursing assessments. Nurse Education Today, 26(8) 662 – 671.

[68].  Tarrant, M. and Ware, J. (2008). Impact of item – writing flaws in multiple choice questions on student achievement in high – stakes nursing assessments. Journal of Medical Education, 42(2) 198 – 206. accessed on 09/03/14 at 20:40 hours.

[69].  Titler, M. Dochterman, J. Kim, T. Kanak, M. Shever, L. Picone, D.M. Everett, L. Budreau, G. (2007). Cost of care for seniors hospitalized for hip fracture and related procedures. Nursing Outlook, 55(1), 5-14

[70].  Trochim, W. M. (2002). The Research Methods Knowledge Base, 2nd Edition. Available online at: http://trochim.human.comell.edulkb/index.htm.

[71].  Van derHorst, H. and McDonald, R. (2003). Outcome – based Education. Theory and Practice: 2nd edition. South Africa. Kagiso Publishers.

[72].  Zheng, A.Y. Lawhorn, J.K. Lumley and Freeman, S. (2008). Education forum: Application of Bloom’s Taxonomy debunks the “MCAT Myth”. Science, 319, 414 – 415.