Bakgrund: Pupillövervakning är en del i den neurologiska bedömningen med hög relevans för neurokirurgiska intensivvårdspatienter. Den finns även beskriven som del i smärt- och sederingsövervakning. Syfte: Att undersöka hur specialistsjuksköterskor inom neurokirurgisk intensivvård använder sig av pupillövervakning i sitt arbete. Metod: Studien utfördes som en semistrukturerad intervjustudie. Sex sjuksköterskor verksamma inom neurokirurgisk intensivvård intervjuades. Materialet analyserades och presenterades i form av teman och kategorier. Resultat: De två teman som framkom var Att följa förlopp och Att utvärdera tillförlitlighet. Att följa förlopp innebar att pupillövervakningen beskrevs som en del i att följa patientens status och för att vidta, avvakta med och utvärdera omvårdnadsinterventioner. Dokumentering och rapportering av pupillövervakningen visade sig ha stor betydelse för att följa patientens förlopp. I temat Att utvärdera tillförlitlighet framkom att sjuksköterskorna, med hjälp av pupillövervakning, beskrevs skilja faktiska förändringar i patientens status mot felvärden på grund av tekniska problem, men även för att kontrollera om en känsla hos sjuksköterskan överensstämde med verkligheten. Slutsats: Vårt resultat har visat att specialistsjuksköterskor inom neurokirurgisk intensivvård använder pupillövervakning inte bara för att följa patienters status och för att utvärdera interventioner utan även för att utvärdera tekniken och känslans tillförlitlighet. / Background: Pupil monitoring is part of the neurological assessment of high relevance to the neurosurgical intensive care patients. It is also described as part of pain and sedation monitoring. Objective: To investigate how specialist nurses in neurosurgical intensive care use pupil monitoring in their work. Method: The study was conducted as a semi-structured interview study. Six nurses working in neurosurgical intensive care were interviewed. The material was analyzed and presented in terms of themes and categories. Results: The two themes that emerged were To follow the course and To evaluate reliability. To follow the course meant that the pupil monitoring was described as part of monitoring and evaluating patient status and to take, defer, and evaluate nursing interventions. Documentation and reporting of pupil monitoring proved to be very important to follow patients' progress. The theme To evaluate the reliability revealed that nurses, with the help of pupil supervision, was described to distinguish actual changes in patient status to error values because of technical problems, but also to verify whether a sense of the nurse were in line with reality. Conclusion: Our results have shown that specialist nurses in neurosurgical intensive care use pupil monitoring not only to monitor patients' status and to evaluate interventions but also to evaluate the technology and reliability of emotional influence.

Until the developments in computer technology, linear test administrations within classical test theory framework is mostly used in testing practices. These tests contain a set of predefined items in a large range of difficulty values for collecting information from students at various ability levels. However, placing very easy and very difficult items in the same test not only cause wasting time and effort but also introduces possible extraneous variables into the measurement process such as possibility of guessing, chance of careless errors induced by boredom or frustration. Instead of administering a linear test there is another option that adapts the difficulty of test according to the ability level of examinees which is named as computerized adaptive test. Computerized adaptive tests use item response theory as a measurement framework and have algorithms responsible for item selection, ability estimation, starting rule and test termination. The present study aims to determine the applicability of computerized adaptive testing (CAT) to Turkish Pupil Monitoring System&rsquo / s (PMS) mathematics assessments. Therefore, live CAT study using only multiple choice items is designed to investigate whether to obtain comparable ability estimations. Afterwards, a Monte Carlo simulation study and a Post-hoc simulation study are designed to determine the optimum CAT algorithm for Turkish PMS mathematics assessments. In the simulation studies, both multiple-choice and open-ended items are used and different scenarios are tested regarding various starting rules, termination criterion, ability estimation methods and existence of exposure/content controls. The results of the study indicate that using Weighted Maximum Likelihood (WML) ability estimation method, easy initial item difficulty as starting rule and a fixed test reliability termination criterion (0.30 standard error as termination rule) gives the optimum CAT algorithm for Turkish PMS mathematics assessment. Additionally, item exposure and content control strategies have a positive impact on providing comparable ability estimations.