Designing A Course(3.19.08)v.fd

Designing Course Running head: DESIGNING A COURSE

Designing a College Level Nursing Course Aaron A. Almassy Ferris State University

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Abstract This document represents this student’s endeavor of developing a course design aimed at the Associate Degree in Nursing (ADN) student. The paper begins with an overview of the course, followed by five objectives developed by the author to evaluate the overall attainment of new knowledge by the student. The objectives are written utilizing the three domains of learning as outlined by Billings and Hallstead (2005). A description of a class session in intravenous (IV) insertion is presented. Furthermore, three additional objectives in relation to the class session will be offered. The author has chosen a textbook for the class, and a critique utilizing the Texas Textbook Evaluation Tool (TTET) is included. Finally, assignments for student preparation are made available.

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Introduction to the Course Nursing 205 is an intermediate level approach to the world of adult medical and surgical nursing in the ADN program. The emphasis of this course is on intermediary nursing concepts of the adult medical patient. The concepts covered in this course are as follows: mid-level health history and physical assessment, pathophysiology (from the cellular level), and mechanisms of disease and the associated nursing care. Included under pathophysiology and mechanisms of disease are: problems associated with altered sensory input, problems associated with oxygenation and ventilation, problems associated with ingestion, digestion, absorption, and elimination, problems related to homeostatic mechanisms, and problems with movement and coordination. The course also focuses on the nursing care, and procedures that the nurse will encounter while caring for the individuals experiencing these problems. This course builds upon the fundamental knowledge that the student has already acquired in previous nursing courses. The course also focuses on the application of the course work to the diverse medical patient population via hands-on demonstration, clinical practice, and competency testing of the material throughout the semester. Objectives for the Course 1) Throughout this course, the student will be able to perform intermediate level nursing functions at the patient bedside with the adult client and become familiar with the anticipation and planning of procedures and other nursing care based upon the presentation of the patient. The psychomotor domain is used to write this objective as it applies to the performance of learned materials. DeYoung (2003) states, “In the psychomotor domain you can observe what learners are actually doing when they perform a skill. Learners can demonstrate what they have learned and you can rate their performance” (p. 41). This objective can be measured by developing and utilizing an evaluation tool that the clinical instructor can use to check off while the student performs the procedure at the bedside. The student’s demonstration of the insertion of a peripheral IV provides a good example of when to use a check-off tool. The instrument developed would include statements like; the student identified and gathered all necessary

equipment needed for the procedure prior to beginning the procedure. Throughout the course, the student will perform this and other various procedures in a laboratory setting, then carry out the procedures with actual patients in the clinical setting under direct supervision of the clinical instructor or instructor’s designee. 2) By the end of the course, the student will develop knowledge of the nursing process and care standards related to the law for safe and effective nursing practice at the ADN level. The American Nurses Association (ANA) (1998) determines the Standards of Clinical Nursing Practice, and publishes them in its book under the same name. As the ANA (1998) states, “As the professional organization for all registered nurses, ANA is responsible for developing generic standards that apply to the practice of all professional nurses” (p.1). The ANA sets six standards of care, which are: assessment, diagnosis, outcome identification, planning, implementation, and evaluation. Likewise, it sets eight standards of professional performance including quality of care, ethics, collaboration, and research among others (ANA, 2008). The goal of the instructor here is to generate highly effective nurses with the preparation and abilities to safely and actively care for their clients. This goal is written utilizing the cognitive domain because it pertains to knowledge acquired via lectures mainly, but additionally by review of literature (Billings & Hallstead, 2005). In order to measure the level of proficiency of an objective in this domain, students will be required to pass multiple exams during the course with minimum 80 percent average by the end of the semester (Bradshaw & Lowenstein, 2007). 3) At the conclusion of this course, the ADN student will appropriately and effectively perform a head-to-toe assessment of an adult, with specific focus on the neurological examination. The psychomotor domain was utilized in writing this objective. The psychomotor domain was chosen because the students are performing a logical procedure using manual motor skills. As Billings & Hallstead (2005) note, manual motor skills are those utilized while implementing tasks such as physical assessments. Evaluation of this objective will be based upon successful completion of return demonstration of the head-to-toe assessment including an indepth neurological assessment. Successful completion is determined by the student meeting a 90

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percent accuracy criterion. Students will be evaluated based on a grading rubric that will be supplied to them by the instructor. 4) At the conclusion of this course, the student will be able to apply concepts involved with holistic nursing care, and providing care for their patients in a non-judgmental manner. The affective domain of learning is used for this objective. As Billings and Hallstead (2005) note, this domain includes feelings, emotions, attitudes, beliefs, and values. We as nurses must always strive to find the value in the human beings we serve. Evaluation of this course objective will make necessary the usage of a Likert scale. When we want to know the feelings, and attitudes of our respondents we should consider using Likert scale questions (Waddington, 2000). The instructor would administer Likert scale pre and post tests at the beginning and end of a semester, respectively. This approach would prove valuable in measuring the students’ selfawareness regarding certain value and emotional laden topics. The instructor would also examine the perceived changes in student awareness from student perspective at the beginning and end of the course. 5) By the end of the course, the student will be able to describe how changes in the American health care system have affected the delivery of patient care as related to nursing. This objective is written using the cognitive domain. This objective focuses on information and knowledge learned mainly from in-class lecture, associated assigned readings and other researchbased activities (Billings & Hallstead, 2005). A class project related to the American health care system will be integrated into the fulfillment of this objective. Each student will do research in regard to a sub-topic of the larger topic of American health care. For example, a student may choose to compose a presentation based on the premise of universal health care coverage in America. The student will write an essay on the sub-topic of their choice and also develop an inclass presentation delivered in the method of the student’s choosing. A grading rubric will be made available to the student in order to help guide him or her in preparation of the paper and presentation. The student must also score at least a combined 80 percent on the paper and presentation in order to pass this objective. Additionally, this portion of the student’s grade will

account for 30 percent of the student’s overall grade in the course. Class Session Involving the Insertion of Peripheral IV Lines The class session that has been identified to be taught is one concerning the insertion and maintenance of peripheral IV lines. First, a brief lecture, followed by a question and answer period will be provided by the instructor. Lecture will focus on the proper, prudent, and safe implementation of an IV access point. As the lecture is being carried out, the instructor will provide visual aides for the students, including tourniquets, IV needles and catheters, and IV tubing sets, so that students can start to become familiar with handling these objects. The students will need additional instruction on identifying venous structures that are appropriate for IV insertion. Objectives for Learning •

Students will enhance their knowledge of safe, appropriate, and effective peripheral IV insertion.

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Students will understand and be able to articulate possible complications associated with peripheral IV insertion.

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The student will be able to successfully demonstrate the insertion and dressing of an IV device serving as a Saline Lock (SL). Class Content and Organization of Content This class session will take place in the nursing skills laboratory setting. The instructor

will utilize a mannequin to exhibit the insertion, dressing, and flushing of a peripheral IV access point. Necessary supplies will be obtained and organized on an over bed table at the appropriate height for the nurse. The instructor will emphasize the importance of patient privacy by pulling the curtain around the patient and/or closing the entry door to the room. The instructor should then perform the appropriate hand washing technique and begin explanation of the procedure to the patient. Once the explanation of the procedure has been completed, the instructor moves on to the assessment of possible access points. The instructor will explain the importance of making the initial venipuncture distally in the

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extremity to maintain more proximal sites of insertion for possible usage later in the course of treatment (Proehl, 2004). The instructor will proceed with the demonstration, by completing the IV insertion in the mannequin, dressing the IV, and explaining the procedure of flushing the IV; allowing for questions throughout the demonstration period. Immediately following the demonstration, the students will be given appropriate time to practice this new skill. Some portions of this practice may be better served by students utilizing one another, in role playing of the patient-nurse dynamic. This would certainly improve the realism of the practice scenario. For example, one could visualize the effect a tourniquet has on constricting and engorging veins for venipuncture. Course Text The text chosen for this course is Medical-Surgical Nursing Assessment and Management of Clinical Problems, seventh edition, authored by Lewis, Heitkemper, Dirksen, O’Brien, and Bucher (2007). One reason this particular text was chosen was because the author was taught with a previous version of this text, and found the text to be very helpful. The text was critiqued and rated according to the TTET as presented by DeYoung (2003). The TTET proved to be extremely useful as a guide for evaluation while assessing this and other possible choices for an appropriate textbook. As completed by the author, the text chosen scored a 2.78 for the T-Test Rating, correlating to an approximate 92 percent score overall (DeYoung, 2003). This text would be a good choice for first and second year nursing students. The importance of being able to utilize this text over the course of two years really becomes apparent when considering the cost of the text, approximately $110. As noted by DeYoung (2003) “Instructors should be conservative with learners’ money and should find out the cost of books under consideration” (p. 47). The text also serves as a good choice for students because of its easy readability, appropriateness for nursing, and provision of excellent illustrations and photographs of procedures and certain disease processes such as diabetic foot ulcers. Considering the score of 92 percent on the TTET, the author concludes that this text would most likely have a positive impact on students in this course as it did on the author.

Student Preparation In order to prepare for a class concerned with IV insertion, the student would be prompted to read an appropriate section from the textbook identified previously. To accompany that reading, selected other readings of the instructor’s discretion will be provided to enhance and expand upon the textbook. Additionally, the student would be made aware of multimedia learning experiences available in the nursing audio-visual technology laboratory. The purpose of additional learning opportunity is to supplement the readings, and providing for alternative means of information presentation. As written by Bradshaw & Lowenstein (2007) “The classroom environment should be fresh and challenging each time the class meets. Faculty should endeavor to provide variety in the manner in which they teach, rather than the same, predictable, albeit comfortable method of telling, rather than teaching” (p.10). Furthermore, the nursing skills laboratory would be open for the practice of skills prior to formal evaluation in the form of a return demonstration, also in the laboratory setting. Conclusion In summary, this student’s design of a Nursing 205 Intermediate Adult Nursing course is presented within this work. The student developed a number of objectives utilizing the three domains of learning. Evaluation methods were devised for each of the objectives in order to gain understanding of the student’s attainment of knowledge. A 20 minute class session was identified, and class content was selected and organized. Another list of objectives was created for the 20 minute class session as well. The course textbook was chosen based on an evaluation utilizing the TTET. Student preparation for the course was also outlined.

References

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The American Nurses Association (1998). Standards of clinical nursing practice. (2nd ed.). Washington, DC: American Nurses Publishing. Billings, D., & Halstead, J. (2005). Teaching in nursing a guide for faculty. (2nd ed.). St. Louis, MO: Elsevier Saunders. Bradshaw, M., Lowenstein, A. (2007). Innovative teaching strategies in nursing and related health professions. (4th ed.). Sudbury, MA: Jones and Bartlett Publishers. DeYoung, S. (2003). Teaching strategies for nurse educators. Upper Saddle River, New Jersey: Pearson Education, Inc. Lewis, S., Heitkemper, M., Dirksen, S., O’Brien, P., & Bucher, L. (2007). Medical-surgical nursing assessment and management of clinical problems. (7th ed.). St. Louis, MO: Mosby Elsevier. Proehl, J. (2004). Emergency nursing procedures. (3rd ed.). St. Louis, MO: Saunders Elsevier. Waddington, H. (2000). Types of survey questions. Encyclopedia of Educational Technology. Retrieved March 15, 2008, from http://coe.sdsu.edu/eet/Articles/surveyquest/start.htm