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Preliminary Design Project Bronchitis and Emphysema 1

Preliminary Design Project Bronchitis and Emphysema

By

Lisa M. Otto

University of North Texas

CECS 6020 Advanced Instructional Design: Models and Strategies


Overview

The method of delivery for the bronchitis and emphysema lesson is a face-to-face course

using the learning management system Canvas to deploy objectives, reading assignments, lesson

materials, and student assignments. The examination method is a computerized exam executed

through the program Examsoft. The bronchitis and emphysema lesson is divided into four

modules. Module one consists of pathology, etiology, diagnostic tests, laboratory results, severity

classifications, clinical manifestations, and potential complications of bronchitis. Module two

consists of pathology, etiology, diagnostic tests, laboratory results, severity classifications,

clinical manifestations, and potential complications of emphysema. Module three consists of

applicable respiratory medications including classification, mechanism of action, drug effects,

indications, contraindications, adverse effects, indications, and dosages. Module four consists of

the application and critical thinking activities including comparing and contrasting bronchitis and

emphysema, interpreting arterial blood gases, designing a concept map, designing a medication

care plan, designing a patient care plan, and evaluating a concept map and both care plans.

Modules one, two, and three focus more on concrete learning of the disease process and

medication treatments, while module four emphasizes analysis, synthesis, and application.

Problem Situation

Today’s higher education and nursing education are experiencing a knowledge explosion

and sweeping changes (Billings, 2012). Health care reform, decreasing financial resources in

healthcare and education, integration of evidence-based practice, expanding technology, shifting

emphasis to learning instead of teaching, and a critical shortage of nursing faculty are some of

the driving forces behind these changes (Billings, 2012). Since, the Pathophysiology and

Pharmacology II course is experiencing a higher than normal fail rate and the National Council


Licensure Examination (NCLEX) pass rate for the program is declining, the focus is on

improving student learning and performance. In an endeavor to align the bronchitis and

emphysema course content with current trends in nursing education the instructional design of

the lesson includes evidence-based practice, strategies for critical thinking, and application of

knowledge, as well as the use of current technology such as computer based exams, a learning

management system, and an audience response system. The design incorporates a student

centered learning environment which expands content delivery beyond information only

encompassing demonstration, application, problem-centered strategy, peer-collaboration, and

peer-critique.

Goal

1. Demonstrate critical thinking to make patient centered care decisions when caring for a

patient with bronchitis or emphysema.

Objectives

Terminal Objectives Enabling Objectives

Upon completion of the unit, the student will be able to:

1. Design a concept map of bronchitis and emphysema (combined or separate) with pathology linked to etiology, diagnostic tests, laboratory results, severity classifications, clinical manifestations, potential complications, and respiratory medication therapy.

1.1 Define bronchitis including chronic productive cough criteria.

1.2 Define emphysema including lung changes in air spaces and walls.

1.3 Identify the clinical manifestations of bronchitis and emphysema.

1.4 Describe the pathophysiology of bronchitis and emphysema including inflammation, airflow limitations, gas exchange abnormalities, mucous production, and vascular changes.

1.5 Discuss pathology links to potential


complications of bronchitis and emphysema.

1.6 Discuss acid-base imbalance and arterial blood gas abnormalities in bronchitis and emphysema

1.7 Discuss types of patient data to use when planning care to decrease risk and predict potential complications for a patient with bronchitis and emphysema.

1.8 Identify the mechanism of action and drug effects, indications, contraindications, adverse effects, indications, and dosages of respiratory medications.

1.9 Evaluate a concept map of bronchitis and emphysema (combined or separate) using a rubric.

Upon completion of the unit, the student will be able to:

2. Plan patient care for a patient with bronchitis or emphysema including respiratory medication therapy using critical thinking and the nursing process such as assessment, planning, nursing diagnosis, implementation, and evaluation.

2.1 Compare and contrast bronchitis and emphysema definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching.

2.2 Describe the implementation of the nursing process including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to medication therapy.

2.3 Design a care plan for a patient with bronchitis or emphysema including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to the disease process.

2.4 Interpret arterial blood gases determining the respiratory system acid-base imbalance.

2.5 Evaluate a care plan for a patient with bronchitis or emphysema using a rubric.

2.6 Design a care plan for a patient with bronchitis or emphysema focusing on respiratory


medication administration and patient teaching.

2.7 Design a respiratory medication care plan including patient teaching.

2.8 Evaluate a respiratory medication care plan using a rubric.

Scope of the Unit

The foci of the lesson are bronchitis and emphysema. The instruction encompasses the

pathophysiology of airflow limitation, the related effects on the body, and treatment. The initial

content focus is bronchitis and emphysema definition, etiology, pathophysiology, clinical

manifestations, severity classifications, complications, diagnostic studies, laboratory results, and

medication treatments including inhalers and patient teaching (Lewis, 2014). The second content

focus is medication treatments with antiinflammatory agents, anticholinergics, leukotriene

modifiers, B2-adrenergic agonist (short and long acting) and combination agents including,

mechanism of action, indications, contraindications, interactions, assessment, implementation,

teaching, and evaluation as applicable (Lilley, 2014). The lesson is a part of a larger respiratory

system unit of study encompassing problems of oxygenation and ventilation inclusive of upper

respiratory problems, lower respiratory problems, and obstructive pulmonary diseases. The

lesson does not include other obstructive pulmonary diseases such as asthma, cystic fibrosis, or

bronchiectasis.

Target Learners

The target learners are nursing students pursuing a Bachelor of Science in Nursing (BSN)

in their junior year of college. The class size is one hundred nursing students. Bronchitis and


emphysema are two components of chronic obstructive pulmonary disease taught during the

second semester of nursing school in the Pathophysiology and Pharmacology II course. The

basic knowledge required for understanding the disease processes of bronchitis and emphysema

are established in multiple prerequisite subjects such as biology, chemistry, microbiology,

anatomy and physiology and several specific prerequisite courses including Health Assessment,

Pathophysiology and Pharmacology I, Human Needs I, and Professional Nursing Practice I. Prior

to enrollment in the junior II level courses, students must pass all courses in the junior one

semester with a seventy one percent or higher thus demonstrating proficiency in the following:

(1) physical assessment of each body system, (2) medication administration of all dosage forms

such as topical, inhalation, eye drops, oral, sublingual, subcutaneous, intramuscular, and,

intravenous, (3) sterile dressing changes, (4) restraint application, (5) patient transfers and

mobilization, (6) foley catheterization insertion and removal, (7) compression stocking

application and removal, (8) incentive spirometry, (9) safety assessment and measures, (10)

calculate drug dosages, (11) assess vital signs and normal parameters, (12) interpret arterial

blood gases, and (13) determine causes, clinical manifestations, compensatory mechanisms, and

treatments of respiratory acidosis and respiratory alkalosis. Regarding the respiratory system

assessment, students must demonstrate proficiency in inspection, palpation, percussion, and

auscultation, as well as, determining respiratory rate, symmetric chest expansion, tactile fremitus,

and bronchophony to progress to the junior level two courses (Jarvis, 2012).

Students enrolled in the Pathophysiology and Pharmacology II course must enroll in the

corequisite courses Human Needs II and Professional Nursing Practice II. The corequisite course

Human Needs II builds on the disease pathophysiology by teaching collaborative care and

nursing interventions. The foci are implementation of the nursing process including assessment,


diagnosis, planning, implementation, patient teaching, and evaluation. Bronchitis and

emphysema collaborative care content is made up of (1) smoking cessation, (2) oxygen therapy,

(3) complications of oxygen therapy, (4) breathing retraining, (5) airway clearance techniques,

(6) nutritional therapy, and (6) activity considerations (Lewis, 2014). The corequisite course

Professional Nursing Practice II is a clinical rotation in a hospital environment with a simulation

component. One of the simulation scenarios involves the care of a patient with emphysema or

bronchitis.

Instructional Approach

The foundation for the instructional design of the bronchitis and emphysema lesson is

Gagné’s nine instructional events. The nine instructional events delineate the necessary

conditions for learning and serve as the foundation for instructional design including the

appropriate selection of media (Gagné, 1985). The table depicts the nine instructional events,

cognitive processes and corresponding instructional activities and information.

Gagné’s events of instruction Bronchitis and emphysema unit of instruction

1. Gaining Attention (reception) 1. Tell a story about a patient with bronchitis2. Tell a story about a patient with emphysema

3. Informing learners of the objective

(expectancy)

1. Pose the questions: What is the pathophysiology of airflow

limitation and the related effects on the body What is bronchitis? What is emphysema? How does smoking affect the lungs and

other body systems? What are the effects of air pollution on the

respiratory and other body systems?2. List the objectives on the content page within the

bronchitis and emphysema lesson module of learning management system, Canvas.


3. List the objectives on the course syllabus, unit assignments, PowerPoint slide presentations, and other course materials and assignments.

4. Stimulating recall of [relevant]

prior learning (retrieval)

1. Review key structures and functions of the respiratory system including the gas exchange process.

2. Review assessment techniques of the respiratory system including normal and abnormal findings.

3. Review arterial blood gas (ABG) normal ranges and the acid-base imbalances.

5. Present the [content] stimulus

(selective perception)

1. Build on previous knowledge by presenting bronchitis and emphysema definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, and medication treatments.

2. Present medication treatments with antiinflammatory agents, anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation as applicable.

3. Present acid-base imbalance and ABG interpretation associated with bronchitis and emphysema including respiratory acidosis and respiratory alkalosis.

6. Providing learning guidance

(semantic coding)

1. Show pictures of the structural changes in the lungs due to bronchitis and emphysema.

2. Compare and contrast the pathologic and structural changes due to emphysema and bronchitis.

3. Show pictures of the patients experiencing clinical manifestations of bronchitis and emphysema.

4. Show characterizations (cartoons) representing the clinical manifestations of bronchitis and emphysema such as the blue bloater and the pink puffer.

5. Show characterizations (cartoons) representing the clinical manifestations of hypoxia.

6. Demonstrate arterial blood gas interpretation and relate finding to pathology changes, effects in gas exchange (hypoventilation), clinical manifestations, and compensation. Provide ABG interpretation handout.

7. Include text describing bronchitis and emphysema definition, etiologies, pathophysiology, clinical manifestations, severity classifications,


complications, diagnostic studies, and medication treatments, that students may read and implement Socratic questioning.

Course Assignments1. Reading assignments in the medical-surgical and

pathology textbook associated with bronchitis, emphysema, acid-base regulation, ABG interpretation, respiratory care plan, collaborative care respiratory medications. Individual student assignment.

2. Reading assignment in the pathology textbook associated with bronchitis and emphysema. Individual student assignment.

3. Reading assignments in the pharmacology textbook associated with respiratory drugs. Individual student assignment.

4. Essay questions about cigarette smoking, passive smoking, air pollution, and effects on the lungs structure and function. Small group assignment.

5. Essay questions about bronchitis and emphysema including definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results. Individual student assignment.

6. Medication study guide related to inhalers and treatments with antiinflammatory agents, anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation as applicable. Small group assignment.

7. Eliciting performance (responding) 1. Practice bronchitis and emphysema NCLEX style questions in class with an audience response system including definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.

2. Student completes comparison chart of bronchitis and emphysema depicting definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching. Small group


assignment.3. Student completes bronchitis and emphysema

cased-based questions in a small group regarding disease definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching. Small group assignment.

4. Student designs a concept map of bronchitis and emphysema (combined or separate) including definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching. Small group assignment.

7. Student designs a care plan for a patient with bronchitis or emphysema focusing on respiratory medication administration and patient teaching. Individual student assignment.

8. Student designs a care plan for a patient with bronchitis or emphysema including applicable subjective and objective patient data, nursing diagnosis, interventions including patient teaching, rationale, patient outcome, and evaluation of outcome. Individual student assignment.

8. Providing feedback

(reinforcement)

1. Provide answers and rationale to practice NCLEX style questions and case-based questions.

2. Discuss NCLEX style and case-based questions and answers including rationale and clarification of content not understood.

3. Review test taking strategies such as identification of key words in the stem and tactics for eliminating incorrect answers and choosing the most correct answer.

4. Faculty provides feedback on essay questions. If answers are broad and non-specific or incorrect. Guide student to specific and comprehensive answers.

5. Faculty and peer feedback on respiratory medication study guide.

6. Faculty and peer feedback on comparison chart guiding the student to comprehensive and specific data.

7. Faculty and peer feedback on the concept map guiding the student to comprehensive and specific data.


8. Faculty and peer feedback on respiratory medication care plan. Address trends in misunderstood content relationships to the class.

9. Faculty and peer feedback on the patient care plan. Address trends in misunderstood content relationships to the class.

10. Faculty feedback on all graded assignments addressing misunderstood content relationships.

11. The learning management system canvas automatically scores the quiz. The correct answers and rationale to missed questions are available immediately after the quiz for student review. Schedule private meetings with students as needed after the quiz to provide remediation to individual students as needed

12. The Examsoft software grades the exam. The answers and rationale to missed questions are available immediately after the exam for student review. Schedule private meetings with students as needed after the exam to provide remediation to individual students as needed

9. Assessing performance (retrieval) 1. Ten question unit quiz. NCLEX style multiple choice questions at the application level including ten percent to twenty percent select all that apply question format. Student receives a grade on the quiz.

2. Seventy five question unit exam. NCLEX style multiple choice questions at the application level including ten percent to twenty percent select all that apply question format. Student receives a grade on the exam.

3. Faculty grade bronchitis and emphysema comparison chart according to rubric.

4. Faculty grade the concept map assignment according to an expert response or referenced model.

5. Faculty grade the respiratory medication care plan using a rubric.

6. Faculty grade the patient care plan using a rubric.10. Enhancing retention and transfer

(generalization)

1. Show picture representations of bronchitis and emphysema pathology and have the students identify, describe, and explain the pathology changes, the associated clinical manifestations, and corresponding diagnostic tests include Socratic questioning.

2. Students discuss in small groups the pathology and


potential complications of bronchitis and emphysema including cor pulmonale, exacerbations, acute respiratory failure, depression, and anxiety.

3. Students discuss in small groups the types of patient data to use when planning care to decrease risk and predict potential complications for a patient with bronchitis and emphysema.

4. Students complete bronchitis and emphysema case-based questions in a small group regarding disease definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.

5. Students construct a concept map in a small group of bronchitis and emphysema (combined or separate) including definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.

6. Student constructs a care plan with a focus on respiratory medication administration and patient teaching in a small group.

7. Students construct a patient care plan for a patient with bronchitis or emphysema focusing on respiratory medication administration and patient teaching.

8. Students evaluate/critique another small group’s concept map.

9. Students evaluate/critique another student’s medication care plan.

10. Students evaluate/critique another student’s patient care plan.


Justification of Instructional Approach

The curriculum builds on what the student previously learned representing a spiral design

that is consistent with the constructivist theory (Kearsley, 2016). According to the constructivist

perspective, people create internal representations or mental models in order to explain

experiences (Spector, 2016). “Internal representations constructed by a person typically build on

prior internal constructions, as knowledge and experience considered together are cumulative”

(Spector, 2016, pg. 78). The basic knowledge of the structure, function, and assessment

techniques of the respiratory system are the foundation for an expansion of knowledge to include

disease process, etiology, diagnostic tests, and clinical manifestations to identify during

assessment, as well as treatments such as respiratory system medications.

According to Kearsley (2016), the constructivist instruction principles are concerned with

enabling student readiness, arranging content in a spiral organization, and facilitating

extrapolation. One major theme in the constructivist theory is that learning is active involving the

learner selecting and transforming information and making decisions (Kearsley, 2016). The

learning activities such as designing a concept map and care plan are active process in which the

learner constructs new ideas based on current and past knowledge. The instruction promotes

going beyond the information given which is consistent with the constructivist theory and

principles.

The learning activities such as study guides, cased-based questions, essay questions,

Socratic questioning, concept mapping, care planning, and practice NCLEX style questions are

highly interconnected. The principles of cognitive flexibility theory support interconnected

knowledge sources as opposed to compartmentalized (Kearsley, 2016). According to Kearsley


(2016), “cognitive flexibility theory focuses on the nature of learning in complex and ill

structured environments.” Cognitive flexibility refers to the ability to restructure knowledge

spontaneously in response to changing situational demands” (Kearsley, 2016). Additionally,

importance is placed on opportunities for learners to construct knowledge (Kearsley, 2016).

Designing the concept map, comparison chart, and care plans facilitates the learner to develop

their own representations of information, restructure and construct knowledge, and learn.

Comparing bronchitis and emphysema in a chart format sparks the student to study

specific details that differentiate the two disease processes. The instruction materials present

specific information from multiple perspectives and use diverse examples and case studies. The

learning activities are consistent with the principles of cognitive flexibility theory, as instruction

is case-based emphasizing knowledge construction in lieu of transmission of information. Two

primary content areas of implementation of cognitive flexibility theory are medicine and biology

and it supports the use of interactive technology such as hyperlinks (Kearsley, 2016).

Today, nursing students are expected to exhibit intellectual skills such as analysis,

synthesis, and meta-cognitive skills. “One of the meta-cognitive techniques is the conceptual

map in which students draw their understanding in an explicit graphical map” (Jaafarpour,

Aazami, & Mozafari, 2016, p. 129). Concept mapping as an educational approach promotes

meaningful learning by allowing students to add new knowledge to existing knowledge in their

cognitive scaffold. In nursing education, concept mapping is used to improve learning, teaching,

and assessment of critical thinking. Since concept mapping is a visual representation of what

students think, it may be used as a method to evaluate learning (Jaafarpour et al, 2016).

Jaafarpour et al (2016) examined the learning strategy of concept mapping to enhance learning

outcomes of nursing students. Jaafarpour et al (2016) reported that “students who engaged in


map construction achieved greater marks on their cumulative tests in comparison to students who

received the traditional teaching methods and take quizzes” (p.131).

“Letting learners know what the expectations are with regard to satisfactory performance

is likely to help learners identify and accept learning goals and objectives, which is especially

critical in formal learning situations” (Spector, 2016, pp.35). Objectives indicate student

expectations regarding what they should know, be able to do, and value at the conclusion of the

lesson including evaluation and grading (Billings, 2012). Each course module in the learning

management system, Canvas, contains a content page with lesson objectives and corresponding

hyperlinks to learning activities. Placing learning activities in close proximity to associated

objectives enables the students to view the learning activities, course objectives, and content

from an interrelated and holistic point of view (Billings, 2012).

Blooms taxonomy is a framework for classifying expectations or intentions of what

students should learn as a result of education. Most frequently, Blooms taxonomy is used to

classify curricular objectives and test items to demonstrate the breadth across the categories

(Krathwolh, 2002). The revised Bloom’s Taxonomy depicts six levels of cognitive processes

remember, understand, apply, analyze, evaluate, and create. The six major categories are

generally a hierarchical representation of increasing complexity with remember being least

complex and create being most complex. However, the objectives involving understanding and

use of knowledge are considered the most important goals in education and classified from

understand to create (Krathwohl, 2002). Placement of the objectives in a table format

representing the six cognitive process dimensions provides an indication of the extent of

complex knowledge and cognitive processes involved (Krathwohl, 2002). The table exhibits the

educational objectives for the bronchitis and emphysema lesson.


Remember Understand Apply Analyze Evaluate Create

Objective 1

Objective 2

Objective 3

Objective 4

Objective 5

Objective 6

Objective 7

Objective 8

Objective13

Objective14

Objective 12 Objective 9 Objective 16

Objective 17

Objective 10

Objective 11

Objective 15

The operant condition theory is a behavioral learning theory accredited to B.F. Skinner

(1954). The basis of this theory is that learning is a function of change in overt behavior.

Reinforcement is the key process involved in such change and designed to encourage desired

consequences (Spector, 2016). “Reinforcers are anything that strengthens the desired response”

(Kearsley, 2016). Some examples of reinforcers are written praise, verbal praise, good grades, or

a feeling of accomplishment (Kearsley, 2016) Operant conditioning’s principles also support

timely and informative feedback to learners (Spector, 2016). The concept of faculty and peer

feedback as well as immediate feedback is threaded throughout the instructional design of the

bronchitis and emphysema lesson.

Formative and Summative Assessment


“A performance of some kind represents an outcomes aspect of learning” (Spector, 2016,

pp.35). Various learning activities and practice activities may involve a performance. Generally,

a learner’s observable response due to a test-item, problem-solving activity, or other learning

situation is performance. Performances are observable, measureable, and linked to learning

outcomes (Spector, 2016). The bronchitis and emphysema lesson incorporates performance

measures including essay questions, comparison chart, study guide, care plan, concept map, quiz,

and exam.

“Formative assessment and learner feedback are critical factors in promoting effective

learning processes (Spector, 2016, pp.32). A goal of formative evaluation is to improve learning

and competence throughout the process of instruction by continual assessment of student

learning, specific student performance feedback, and improving teaching strategies (Baumlen,

2015). Summative evaluation essentially sums up or summarizes the overall achievement of the

student at the end of the instruction, course, or lesson. Overall, the summative evaluation

determines the achievement of the student and outcome of the education. Some examples of

summative evaluation methods include exams, written assignments, cap stone projects, and

course grade (Baumlen, 2015).

According to Spector (2016), “An instructor does not know what learning has occurred

without having some measures or indicators or change in performance or ability” (pg. 36). The

instructional design of the bronchitis and emphysema lesson provides for both formative and

summative assessments including faculty and peer feedback. The essay questions, study guide,

quiz, and comparison chart assignments involve formative feedback. The care plan, concept map,

and seventy five question exam provides summative evaluations of student achievement and

outcome of the education.


Grading rubrics typically guide the student regarding the expectation level for an

assignment, while the teacher uses the rubric to grade the assignment (Baumlen, 2015). “The

most essential characteristic of a robust and meaningful rubric is that the data are measureable

and directly connected to the student learning outcomes the assignment is designated to

measure” (Baumlen, 2015, pp.56). The instructional design is set up such that the essay

questions, study guide, and comparison chart are graded according to a corresponding rubric.

According to Spector (2016), “one can ask a learner to create a representation of the problem

space associated with a particular problem scenario and then compare that response with an

expert response or reference model” (pp.32). The instructional design of the lesson supports the

use of an expert response or reference model to grade the concept map and care plan.

“Learning should be assessed and feedback given to students in a timely manner, enabling

them to see their progress and make decisions about their learning” (Billings, 2012, pg. 85). The

instructional design allows for a learning management system and Examsoft program to grade

quizzes and exams immediately upon completion. The correct answers and rationale to missed

questions are available directly after the quiz for student review.

Tests assess the students’ understanding of content and the ability to think at each level

including remember, understand, apply, analyze, evaluate, and create (Baumlen, 2015). Some

examples of test item formats are multiple choice, true or false, matching, short answer, fill in the

blank, ordered response, and multiple choice with multiple response. The most appropriate item

format selection is based on which format directly measures the intended learning outcome

(Baumlen, 2015). The instructional design supports ninety percent of the test items equating with

understand, apply, analyze, evaluate, and create categories. The bronchitis and emphysema

lesson plan include seventeen objectives in total. Specifically, there are two objectives in the


remember category and fifteen objectives that correlate to the understand through create levels.

According to Mayer (2002), “When the goal of instruction is to promote transfer, objectives

should include the cognitive processes associated with understand, apply, analyze, evaluate, and

create (pp.232).

Evaluation Plan

The term evaluation is used to refer to programs and projects as in ‘evaluating courses’

(Spector, 2016, p.32). Evaluation methods may include student feedback through discussion or

course evaluation, peer review of teaching strategies through classroom observation and

assessment of course materials, and faculty course reports including types of instructional

methods, rationale, and changes to these methods (Billings, 2012). Course faculty, administrative

personnel, and faculty peers may review course evaluations and course reports annually in an

effort to evaluate teaching strategies. Nursing program outcome measures consist of entry and

graduation rates, certificate of graduates, first time pass rate on the National Council Licensure

Examination for Registered Nurses (NCLEX-RN), licensure, postgraduation employment rates,

and employer surveys (Billings, 2012). The implementation of the bronchitis and emphysema

lesson instructional design is evaluated through course evaluations, student feedback, faculty

peer review, faculty course reports, and overall program outcome measures in addition to student

performance on assignments, exams, and final course grade.


References

Baumlein, G. (2015). Use assessment and evaluation strategies. In Caputi, L (Eds.), Certified

Nurse Educator Review Book: The Official NLN Guide to the CNE Exam. Philadelphia,

PA: Wolter Kluwer.

Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty. St. Louis,

MO: Elsevier/Saunders.

Gagne, R. (1985). The conditions of learning (4th ed.). New York: Holt, Rinehart & Winston .

Gagné, R., Briggs, L. & Wager, W. (1992). Principles of instructional design (4th Ed.). Fort

Worth, TX: HBJ College Publishers.

Gagné, R. M., & Merrill, M. D. (1990). Integrative goals for instructional design. ETR&D

Educational Technology Research and Development, 38(1), 23-30.

Huether, S.E., McCance, K.L., Brashers, V.L. & Rote, N.S. (2013). Understanding

pathophysiology (5th ed.). St. Louis: Mosby- Elsevier.

Jaafarpour, M., Aazami, S., Mozafari, M. (2016). Does concept mapping enhance learning

outcome of nursing students? Nurse Education Today, 36, 129-132.

Jarvis, C. (2012). Physical examination and health assessment (6th ed.). Philadelphia: W. B.

Saunders.

Kearsley, G. (2016). The Theory Into Practice Database. Retrieved from

http://InstructionalDesign.org

Krathwohl, D. R. (2002). A revision of bloom's taxonomy: An overview. Theory into

Practice, 41(4), 212-218.

Lewis, S.L., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing:

Assessment and management of clinical problems (9th ed.). St. Louis: Mosby.

Lilley, L.L., Collins, S. R., & Snyder, J. (2014). Pharmacology and the nursing process (7th

http://InstructionalDesign.org/


ed.). St. Louis, MO: Mosby-Elsevier.

Mayer, R. E. (2002). Rote versus meaningful learning. Theory into Practice, 41(4), 226-232.

Richey, R. C. (Ed.) (2000). The legacy of Robert M. Gagné. Syracuse, NY: The ERIC

Clearhinghouse on Information and Technology. Retrieved from

http://eric.ed.gov/?id=ED445674

Spector, J. M. (2016). Foundations of educational technology: Integrative and interdisciplinary

perspectives (2nd ed.). New York: Routledge.

Zerwekh, J., Claborn, J.C., & Miller, C.J. (2007). Memory notebook of nursing: Volume 1

(3rd ed.). Texas: Gingerbread Press.

http://eric.ed.gov/?id=ED445674


Appendix A

Learning Management System Home Page Bronchitis and Emphysema Lesson

Module 2Emphysema

Disease Process

Module 3Respiratory Medications

Module 4Critical Thinking

Exercises

Module 1Bronchitis

Disease Process

Bronchitis and Emphysema Lesson


Appendix B

Learning Management System Module 1 Bronchitis Content Page

Module 1 Pathology, clinical manifestations, and potential complications of bronchitisObjectives 1. Define bronchitis including chronic productive cough criteria.

2. Identify the clinical manifestations of bronchitis.3. Describe the pathophysiology of bronchitis including inflammation, airflow

limitations, gas exchange abnormalities, mucous production, and vascular changes.

4. Discuss pathology links to potential complications of bronchitis.5. Discuss types of patient data to use when planning care to decrease risk and

predict potential complications for a patient with bronchitis.6. Discuss acid-base imbalance and arterial blood gas abnormalities in bronchitis.

Reading Assignment

1. Medical-Surgical textbook pages

2. Pathology textbook pages

3. Medical-Surgical textbook acid base balance and ABG interpretation pagesLesson Materials

1. PowerPoint Lecture Bronchitis (hyperlink)2. ABG Interpretation Handout (hyperlink)

Student Assignment

1. Essay Questions (hyperlink) Topics: Cigarette smoking, passive smoking, air pollution, and effects

on the lungs structure and function, completed in a small group.2. Essay Questions (hyperlink)

Topics: Bronchitis etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching

3. Practice NCLEX Style Questions (hyperlink) In class with audience response system Topic: Bronchitis


Appendix C

Learning Management System Module 2 Emphysema Content Page

Module 2 Pathology, clinical manifestations, and potential complications of emphysemaObjectives 1. Define emphysema including lung changes in air spaces and walls.

2. Identify the clinical manifestations of emphysema.

3. Describe the pathophysiology of emphysema including inflammation, airflow limitations, gas exchange abnormalities, mucous production, and vascular changes.

4. Discuss pathology links to potential complications of emphysema.

5. Discuss types of patient data to use when planning care to decrease risk and predict potential complications for a patient with emphysema.

6. Discuss acid-base imbalance and arterial blood gas abnormalities in emphysema.

Reading Assignment

1. Medical-Surgical textbook pages2. Pathology textbook pages3. Medical-Surgical textbook acid base balance and ABG interpretation pages

Lesson Materials

1. PowerPoint Lecture Emphysema (hyperlink)2. ABG Interpretation Handout

Student Assignment

1. Essay Questions (hyperlink) Topics: Emphysema etiologies, pathophysiology, clinical

manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching

2. Practice NCLEX Style Questions (hyperlink) In class with audience response system Topic: Emphysema


Appendix D

Learning Management System Module 3 Respiratory Medication Content Page

Module 3 Respiratory medications including classification, mechanism of action and drug effects, indications, contraindications, adverse effects, indications, and dosages.

Objectives 1. Identify the mechanism of action and drug effects, indications, contraindications, adverse effects, indications, and dosages of respiratory medications.

Reading Assignment

1. Pharmacology textbook pages2. Davis Drug Guide textbook pages3. Medical-Surgical textbook collaborative care respiratory medications pages

Lesson Materials

1. PowerPoint Lecture Respiratory Medication (hyperlink)

Student Assignment

1. Student Medication Study Guide (hyperlink) Small group work Topic: Inhalers and treatments with antiinflammatory agents,

anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation

2. Practice NCLEX Style (hyperlink) In class with audience response system Topic: Respiratory medications


Appendix E

Learning Management System Module 4 Critical Thinking Content Page

Module 4 Critical Thinking ActivitiesObjectives 1. Compare and contrast bronchitis and emphysema definition, etiology,

pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching.

2. Describe the implementation of the nursing process including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to medication therapy.

3. Design a care plan for a patient with bronchitis or emphysema including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to the disease process.

4. Evaluate a care plan for a patient with bronchitis or emphysema including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to the disease process using a rubric.

5. Design a respiratory medication care plan including patient teaching.

6. Evaluate a respiratory medication care plan using a rubric.

7. Interpret arterial blood gases determining the respiratory system acid-base imbalance.

Reading Assignment

1. Medical-Surgical textbook care plan respiratory care pages2. Care Plan textbook ineffective airway clearance and impaired oxygenation

pages3. Medical-Surgical textbook acid base balance and ABG interpretation pages

Lesson Materials

1. Comparison Chart Directions (hyperlink)2. Care Plan Directions (hyperlink)3. Example Care Plan (hyperlink)4. Concept Map Directions (hyperlink)5. Example Concept Map (hyperlink)6. Example ABG Interpretation Handout (hyperlink)

Student Assignment

4. Comparison Chart (hyperlink) Small group work Topic: Definition, etiology, pathophysiology, clinical manifestations,

complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching

5. Medication Care Plan (hyperlink) Topic: Respiratory medication administration and patient teaching.

6. Patient Care Plan (hyperlink) Topic: Applicable subjective and objective patient data, nursing


diagnosis, interventions including patient teaching, rationale, patient outcome, evaluation of outcome.

7. Concept Map (hyperlink) Small group work Topics: Definition, etiologies, pathophysiology, clinical manifestations,

severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching

1. Case-Based Questions (hyperlink) Small group work Topic: Bronchitis disease definition, etiologies, pathophysiology,

clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.

Topic: Emphysema disease definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.

Topic: Inhalers and treatments with antiinflammatory agents, anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation


Appendix F

Bronchitis Cartoon Character Representation

(Zerwekh, Claborn, & Miller, 2007)


Appendix G

Emphysema Cartoon Character Representation

(Zerwekh et al., 2007)


Appendix H

Chronic Obstructive Pulmonary Disease Cartoon Character Representation



Appendix I

Hypoxia Cartoon Character Representation


· web viewreview arterial blood gas (abg) normal ranges and the acid-base imbalances. present the...

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