Rethinking Theoretical Assessment in Undergraduate Nursing Education: Evidence-Based Best Practice Guidelines :

Gabieba Donough; Katlego Mthimunye; Felicity Daniels

doi:10.25159/2520-5293/21887

Authors

Gabieba Donough University of the Western Cape https://orcid.org/0000-0002-4601-1851
Katlego Mthimunye University of the Western Cape
Felicity Daniels University of the Western Cape https://orcid.org/0000-0003-4550-7887

DOI:

https://doi.org/10.25159/2520-5293/21887

Keywords:

Bloom’s Taxonomy, constructive alignment, Delphi study, evidence-based guidelines, quality assurance, theoretical assessment design

Abstract

The quality of theoretical assessments in undergraduate nursing education is crucial to shaping students’ clinical reasoning, professional judgment, and overall readiness for professional practice. Despite growing emphasis on competency-based education, persistent challenges, including cognitive misalignment, inconsistent moderation practices, limited assessment literacy, and contextual constraints, continue to undermine the credibility and fairness of these assessments.

Aim: To develop and validate evidence-based best-practice guidelines to strengthen the design of theoretical assessments in undergraduate nursing education.

Methods: The study was conducted in two sequential phases. The first phase gathered, synthesised, and integrated evidence from a scoping review, moderation report analysis, qualitative interviews with nurse educators, and a student survey. This process generated 13 draft guidelines with 60 operational statements. A Delphi study was used in the second phase to establish expert consensus amongst 15 national and international nursing education experts on the guidelines and operational statements. Consensus was set at ≥80% agreement on clarity, relevance, and applicability.

Results: All guidelines achieved consensus in the Delphi study. The validated guidelines emphasise the need for assessments based on cognitive taxonomy principles; constructive alignment to enhance theory-practice integration; adherence to core assessment principles; and institutional responsibility for educator development and quality assurance.

Conclusion: The guidelines provide structured guidance to enhance the validity, fairness, and contextual responsiveness of theoretical assessment design. When implemented, they have the potential to strengthen quality assurance processes and advance equitable, competency-driven nursing education in South Africa.

References

Abou Hashish, Ebtsam Aly, Hend Alnajjar, and Hawazen Rawas. 2025. “Voices on Academic Accreditation: Lived Experiences of Nurse Educators, Administrators, Students, and Alumni in Nursing Education.” BMC Medical Education 25(1): 64. https://doi.org/10.1186/s12909-025-06657-2 DOI: https://doi.org/10.1186/s12909-025-06657-2

Ajjawi, Rola Joanna Tai, Mollie Dollinger, Phillip Dawson, David Boud, and Margaret Bearman. 2024. “From Authentic Assessment to Authenticity in Assessment: Broadening Perspectives.” Assessment and Evaluation in Higher Education 49(4): 499–510. https://doi.org/10.1080/02602938.2023.2271193 DOI: https://doi.org/10.1080/02602938.2023.2271193

Akib, Erwin, and Muh Arief Muhsin. 2020. “Critical Thinking in Cognitive Domain: Exploring Assessment of English Teaching in the Pandemic Period of Covid-19.” Journal of English Educators Society 5(2): 178–184. https://doi.org/10.21070/jees.v5i2.752 DOI: https://doi.org/10.21070/jees.v5i2.752

Bazvand, Ali Darabi, and Amirhossein Rasooli. 2022. “Students’ Experiences of Fairness in Summative Assessment: A Study in a Higher Education Context.” Studies in Educational Evaluation 72: 101118. https://doi.org/10.1016/j.stueduc.2021.101118 DOI: https://doi.org/10.1016/j.stueduc.2021.101118

Bennett, Lorraine, and Ali Abusalem. 2024. “Building Academic Integrity and Capacity in Digital Assessment in Higher Education.” Athens Journal of Education 11 (1): 71–94. https://doi.org/10.30958/aje.11-1-5 DOI: https://doi.org/10.30958/aje.11-1-5

Biggs, John. 1996. “Enhancing Teaching through Constructive Alignment.” Higher Education 32(3): 347–364. https://doi.org/10.1007/BF00138871 DOI: https://doi.org/10.1007/BF00138871

Biggs, John. 2003. “Aligning Teaching for Constructing Learning.” Higher Education Academy 1(4): 381–388.

Biggs, John, Catherine Tang, and Gregor Kennedy. 2022. Teaching for Quality Learning at University. 5th ed. Maidenhead: McGraw-Hill Education.

Bloom, Benjamin. 1956. Taxonomy of Educational Objectives: The Classification of Educational Goals. New York: Longman.

Boud, David, and Margaret Bearman. 2024. “The Assessment Challenge of Social and Collaborative Learning in Higher Education.” Educational Philosophy and Theory 56(5):459–468. https://doi.org/10.1080/00131857.2022.2114346 DOI: https://doi.org/10.1080/00131857.2022.2114346

Calaguas, Noriel. 2023. “Mentoring Novice Nurse Educators: Goals, Principles, Models, and Key Practices.” Journal of Professional Nursing 44: 8–11. https://doi.org/10.1016/j.profnurs.2022.11.002 DOI: https://doi.org/10.1016/j.profnurs.2022.11.002

Chukwu, Otuto Amarauche, Jessica Nadigel, Bahar Kasaai, Rhonda Boateng, Richard Glazier, and Meghan McMahon. 2024. “Understanding the Training, Mentorship, and Professional Development Priorities of Early Career Embedded Researchers.” The International Journal of Health Planning and Management 39(5): 1277–1297. https://doi.org/10.1002/hpm.3800 DOI: https://doi.org/10.1002/hpm.3800

Creswell, John, and David Creswell. 2017. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thousand Oaks: SAGE Publications.

Daniels, Carlo Emile. 2026. “Higher Education for Sustainable Development: Brazil and South Africa’s Path Trajectory Towards SDG 4.” In The BRICS Imperative: Confronting Climate Challenges and Advancing Sustainable Development, 71–90. Springer. DOI: https://doi.org/10.1007/978-3-032-05932-1_4

Donough, Gabieba. 2024. “Development of Best Practice Guidelines for the Design of Theoretical Assessments in an Undergraduate Nursing Programme at a Higher Education Institution in the Western Cape.” Doctoral thesis; University of the Western Cape.

Donough, Gabieba, Felicity Daniels, and Katlego Mthimunye. 2022. “Designing Theoretical Assessments at Nursing Higher Education Institutions: A Scoping Review.” South African Journal of Higher Education 36(2): 79–98. DOI: https://doi.org/10.20853/36-2-4699

Donough, Gabieba, Katlego Mthimunye, and Felicity Daniels. 2025a. “Quality Assurance: A Document Review of Moderation Reports on Final Theoretical Assessments.” Health SA Gesondheid 30: 1–7. https://doi.org/10.4102/hsag.v30i0.3024 DOI: https://doi.org/10.4102/hsag.v30i0.3024

Donough, Gabieba, Katlego Mthimunye, and Felicity Daniels. 2025b. “Strengthening Theoretical Assessment Design in Nursing Education: Advancing SDG 4.” Health SA Gesondheid 30: 1–8. https://doi.org/10.4102/hsag.v30i0.3061 DOI: https://doi.org/10.4102/hsag.v30i0.3061

dos Reis, Karen, Christie Swanepoel, Di Yu, and Fiona Anciano. 2022. “Exploring the Alignment of First-year Summative Assessments with Bloom’s Taxonomy: A Longitudinal Study.” South African Journal of Higher Education 36(5): 37–57. https://hdl.handle.net/10520/ejc-high_v36_n5_a3 DOI: https://doi.org/10.20853/36-5-4784

Dsilva, Fatima, and Prabhu Prathima. 2024. “Measuring Competence: The Journey to Professional Readiness in Nursing Education.” Chinese Journal of Evidence-Based Medicine 20(1): 108–116.

Ellis, Misty, Debra Hampton, Andrew Makowski, Candice Falls, Elizabeth Tovar, Leslie Scott, and Sheila Melander. 2023. “Using Unfolding Case Scenarios to Promote Clinical Reasoning for Nurse Practitioner Students.” Journal of the American Association of Nurse Practitioners 35(1): 55–62. https://journals.lww.com/jaanp/Abstract/2023/01000/Using_unfolding_case_scenarios_to_promote_clinical.9.aspx DOI: https://doi.org/10.1097/JXX.0000000000000806

Ergashevich, Ernazarov Alisher. 2024. “The Role of Bloom's Taxonomy in Determining Pedagogical Objectives in the Process of Educational Lessons.” American Journal of Language, Literacy and Learning in STEM Education (2993–2769) 2 (1): 264–270.

European Society of Human Reproduction and Embryology. 2018. “Guideline Development Process.” Human Reproduction. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Guideline-development-process

Fasanya, Ayodele Gabriel, Simon Adekali Negedu, and Opeyemi Ibrahim AbdulWaheed. 2023. “Quality Assessment for Instructional Process in Tertiary Institutions in Nigeria: Challenges and Way Forward.” Journal of Science, Technology and Mathematics Pedagogy 1(2): 183–201. https://jostmp-ksu.com.ng/index.php/jostmp/article/view/80/52

Hecker, Kent Danielson, Cees van der Vleuten, and Harold Bok. 2024. “Constructive Alignment and Programmatic Assessment.” In Veterinary Medical Education: A Practical Guide, edited by Jennifer Hodgson and Jaquelyn Pelzer, 279–293. New York: Wiley-Blackwell.

Hui, Emily Sein Yue Elim. 2025. “Incorporating Bloom’s Taxonomy into Promoting Cognitive Thinking Mechanism in Artificial Intelligence-supported Learning Environments.” Interactive Learning Environments 33 (2): 1087–1100. https://doi.org/10.1080/10494820.2024.2364237 DOI: https://doi.org/10.1080/10494820.2024.2364237

İlaslan, Emine, Derya Adıbelli, Gamze Teskereci, and Şengül Üzen Cura. 2023. “Development of Nursing Students’ Critical Thinking and Clinical Decision-making Skills.” Teaching and Learning in Nursing 18(1): 152–159. https://doi.org/10.1016/j.teln.2022.07.004 DOI: https://doi.org/10.1016/j.teln.2022.07.004

Irenka, SUTO, and Jo Ireland. 2021. “Principles for Minimizing Errors in Examination Papers and Other Educational Assessment Instruments.” International Journal of Assessment Tools in Education 8(2): 310–325. https://doi.org/10.21449/ijate.897874 DOI: https://doi.org/10.21449/ijate.897874

Jin, Xinglin, Tongji Li, Jacobiene Meirink, Anna Van Der Want, and Wilfried Admiraal. 2021. “Learning from Novice–expert Interaction in Teachers’ Continuing Professional Development.” Professional Development in Education 47(5): 745–762. https://doi.org/10.1080/19415257.2019.1651752 DOI: https://doi.org/10.1080/19415257.2019.1651752

Köksal, Dinçay, and Ömer Gökhan Ulum. 2018. “Language Assessment through Bloom’s Taxonomy.” Dil ve Dilbilimi Çalışmaları Dergisi 14(2): 76–88. https://dergipark.org.tr/en/pub/jlls/issue/43364/527924

Lestari, Septia Sri, and M Sirozi. 2025. “Bloom’s Taxonomy Theory and the Challenges of its Implementation in Education.” Journal of Educational Sciences 9(6): 6043–6055. 10.31258/jes.9.6.p.6043-6055

Luna‐Aleixos, David, Víctor M González‐Chordá, Marta Aquilué‐Ballarí, Irene Llagostera‐Reverter, Gema Mecho‐Montoliu, Águeda Cervera‐Gasch, María Jesús Valero‐Chillerón, Desirée Mena‐Tudela, and Laura Andreu‐Pejó. 2023. “Developing and Validating an Integrated Instrument for Nursing Assessments in Adult Hospitalization Units: Study Protocol.” Nursing Open. https://doi.org/10.1002/nop2.1602 DOI: https://doi.org/10.1002/nop2.1602

Mallari, Cristina Beatrice, Jayne Lois San Juan, and Richard Li. 2023. “The University Coursework Timetabling Problem: An Optimization Approach to Synchronizing Course Calendars.” Computers and Industrial Engineering 184: 109561. https://doi.org/10.1016/j.cie.2023.109561 DOI: https://doi.org/10.1016/j.cie.2023.109561

Melnyk, Bernadette Mazurek, and Ellen Fineout-Overholt. 2022. Evidence-based Practice in Nursing and Healthcare: A Guide to Best Practice. (ebook) Lippincott Williams & Wilkins.

Mosabala, Mpho. 2025. “Internal Quality Assurance Practices at Universities in South Africa.” INTED2025 Proceedings, South Africa. DOI: https://doi.org/10.21125/inted.2025.1120

Paterson, Catherine, Nathan Paterson, William Jackson, and Fiona Work. 2020. “What are Students’ Needs and Preferences for Academic Feedback in Higher Education? A Systematic Review.” Nurse Educ Today 85: 104236. https://doi.org/10.1016/j.nedt.2019.104236 DOI: https://doi.org/10.1016/j.nedt.2019.104236

Prichard, Roslyn, Jacqueline Peet, May El Haddad, Yingyan Chen, and Frances Lin. 2024. “Assessment Moderation in Higher Education: Guiding Practice with Evidence-An Integrative Review.” Nurse Education Today 106512. https://doi.org/10.1016/j.nedt.2024.106512 DOI: https://doi.org/10.1016/j.nedt.2024.106512

Scaled Agile Framework, SAFe. 2021. “How is the Time on an Exam Determined.” Scaled Agile Framework. Scaled Agile Inc. https://support.scaledagile.com/s/article/FAQ-How-is-the-time-on-an-exam-determined?language=en_US

Shivshankar, Smitha. 2024. “Assessment Integrity and Assessment Security in the Digital Era.” In Teaching and Learning in the Digital Era: Issues and Studies, 137–163. World Scientific. DOI: https://doi.org/10.1142/9789811285622_0005

Shohani, Masoumeh, Mohammadreza Bastami, Leili Abedi Gheshlaghi, and Abbas Nasrollahi. 2023. “Nursing Student’s Satisfaction with Two Methods of CBL and Lecture-based Learning.” BMC Medical Education 23(1): 1–5. https://doi.org/10.1186/s12909-023-04028-3 DOI: https://doi.org/10.1186/s12909-023-04028-3

Smith, Sheila, Mary Mescher Benbenek, and Lauren Petersen. 2025. “Diagnostic Reasoning Foundations: Theoretical and Scientific Background with Suggested Competencies for Nurse Practitioner Education.” AACN Advanced Critical Care 36(2): 109–122. https://doi.org/10.4037/aacnacc2025354 DOI: https://doi.org/10.4037/aacnacc2025354

Sobral, Sónia Rolland. 2021. “Bloom’s Taxonomy to Improve Teaching-learning in Introduction to Programming.” International Journal of Information and Education Technology 11(3): 148–153. https://doi.org/10.18178/ijiet.2021.11.3.1504 DOI: https://doi.org/10.18178/ijiet.2021.11.3.1504

Stoltenkamp, Juliet, and Paul Dankers. 2023. “Leadership in Education: The Impact of Leadership on the Successful Implementation and Support of Remote Teaching, Learning and Assessment.” EDULEARN23 Proceedings. DOI: https://doi.org/10.21125/edulearn.2023.0222

Villarroel, Verónica, David Boud, Susan Bloxham, Daniela Bruna, and Carola Bruna. 2020. “Using Principles of Authentic Assessment to Redesign Written Examinations and Tests.” Innovations in Education and Teaching International 57(1): 38–49. https://doi.org/10.1080/14703297.2018.1564882 DOI: https://doi.org/10.1080/14703297.2018.1564882

Villarroel, Verónica Daniela Bruna, Carola Bruna, Gavin Brown, and David Boud. 2024. “Authentic Assessment Training for University Teachers.” Assessment in Education: Principles, Policy and Practice 1–19. https://doi.org/10.1080/0969594X.2024.2350395 DOI: https://doi.org/10.1080/0969594X.2024.2350395

Wong, Su Hui Valynn, and Yanika Kowitlawakul. 2020. “Exploring Perceptions and Barriers in Developing Critical Thinking and Clinical Reasoning of Nursing Students: A Qualitative Study.” Nurse Education Today 95: 104600. https://doi.org/10.1016/j.nedt.2020.104600 DOI: https://doi.org/10.1016/j.nedt.2020.104600

Xavier, Marlon, and Julio Meneses. 2022. “Persistence and Time Challenges in an Open Online University: A Case Study of the Experiences of First-year Learners.” International Journal of Educational Technology in Higher Education 19(1): 31. https://doi.org/10.1186/s41239-022-00338-6 DOI: https://doi.org/10.1186/s41239-022-00338-6

Zickafoose, Alexis, Olawunmi Ilesanmi, Miguel Diaz-Manrique, Anjorin E Adeyemi, Benard Walumbe, Robert Strong, Gary Wingenbach, Mary T Rodriguez, and Kim Dooley. 2024. “Barriers and Challenges Affecting Quality Education (Sustainable Development Goal# 4) in Sub-Saharan Africa by 2030.” Sustainability 16(7): 2657. https://doi.org/10.3390/su16072657 DOI: https://doi.org/10.3390/su16072657