Using Constructivist design for preparing an online course allows the adult learner to apply knowledge gained from the material covered in the course to be applied to their personal life experiences and knowledge, therefore allowing them to construct new knowledge onto the old (O'Neil, Fisher, & Newbolt, 2009). Many adult learners excel with this type learning environment. It is important that the instructor keeps this in mind when creating any type of course. In order to better facilitate a student centered learning atmosphere.
Knowing the target population of the group of people that you are focusing any educational program on is one of the first steps in designing any course (O'Neil, Fisher, & Newbolt, 2009). As an educator, you not only need to have a general understanding of adult learning styles, but also how to adjust the curriculum to the target population and their learning styles. With changes of the health care reform placing more of the focus on patient education in order to reduce costly hospital re-admission rates, hospitals are focusing on finding better ways to educate patients and their families. With current heart failure rates at 4.8 million people (National Heart, Lung, and Blood Institute, 1996) in the United States and climbing. Patients with first time diagnosis of CHF result in 875,000 hospitalizations each year. The majority of these patients are 65 years or older. According to the NHLBI, in 1994, data showed that CHF was the first discharge diagnosis in 874,000 cases and as a secondary diagnosis in 1.8 million (1996). Re-admission rates range with 30-40% if patients within six months of which 40% of those that could have been prevented (Hoyt & Bowling, 2001).The focus of patient education efforts are now driving the healthcare system to provide patients more education upon discharge and throughout their hospitalization. The bulk of this education is falling into the hands of nursing to perform as nurses are responsible for discharge teaching.
When presenting any type of educational teaching it is important to identify to the learner not only the topic to be discussed, but the objectives that are to be obtained with completion of the course. According to O’Neil, objectives need to be stated not only in measureable terms so that the student will have a better understanding of what will be accomplished through the learning experience (2009). In this course the learner will leave with a better understanding of what CHF is, the effects on the persons daily living activities, treatment including medication management, when to call the doctor, daily weights, etc…, as well as exercise and diet all in order to help prevent or reduce the amount of re-hospitalizations. With changes in National healthcare policy and Medicare spending Congress and President Obama have identified reducing the amount of re-hospitalizations as a way of cutting Medicare’s immense budget (Stone & Hoffman, 2010).
According to O’Neil, course objectives should be based on measurable outcomes and should establish what the student will accomplish from the material covered in the course (2009). For this course the outcome will result in educating patients and their families about their diagnosis and treatment therefore, resulting in reducing the number of hospital readmissions. According to Bloom’s taxonomy, this will be accomplished by covering two of the three domains. Objective one using the cognitive domain, will increase the students knowledge of CHF and it’s affects on the body. Bloom states that using the cognitive domain allows an increase in knowledge and development of intellectual skills (Unknown, 2010). By creating an educational environment allowing the student to increase their knowledge and comprehension on a subject such as CHF the instructor helps guide them to a better understanding of the disease and how it affects the body. In objective two, the learner will use a combination of cognitive and psychomotor domains. They will be able to apply knowledge gained in the first objective to the second objective. In doing so, the student will be able to apply and analyze how the information gained in the first objective applies to and affects the behavior changes learned in the second. Using the psychomotor domain in the second objective educates adult learners on how to make changes in their lifestyles in order to achieve an improvement in their quality of life and reduce hospitalizations by gaining an understanding of how modifying and adapting to changes in their lifestyles can help increase their quality of life. This is accomplished by helping the patient to identify ways to effective manage symptoms through changes in behavior (Unknown, 2010) and the ability to recognize when they need to seek further medical management of their disease. This is accomplished by providing the patient education on medication adherence, diet, exercise, as well as skills in management of symptoms like weight gain and fluid restrictions.
Course organization should take into consideration how to best present the information in a way that learners are able to build on previous content to increase their knowledge. In order to do this several things need to be considered such as content, structure, activities, and the use of multimedia. In doing so, the course should be easy to navigate and put in a logical order building upon the current knowledge of the learner (O'Neil, Fisher, & Newbolt, 2009).
The course content will cover information such as basic statistics about the number of cases of CHF. Such as how many are affected by CHF. CHF will be defined in order to help patients to understand that CHF is a disease that affects the ability of the heart to effectively pump blood to the rest of the body (U. S. National Library of Medicine and National Institutes of Health, 2011). The course will cover symptoms, tests, and treatment. In covering information on treatment the importance of medication adherence, diet modification (low salt, low fat diet), daily weights, and exercise. It will also touch on ways that can make CHF worse as well as better. The course will also help patients understand the importance of when to seek medical professionals such as with sudden weight gain or increase in shortness of breath. The course will wrap up by helping the learner to apply the information gained to helping managing their disease successfully and decreasing the number of re-admissions to the hospital and improve their quality of life by proper disease management working with their health care providers.
Since this is a course that is designed to educate patients after diagnosis prior to, during, and after the discharge process it can be presented in four ways. First, in a classroom environment with a small group of patients and their families that have been recently discharged during several meetings of about one hour over a four week period. Secondly, the class material would be covered via the TV and internet in the inpatient rooms given several times a day that could be tuned into. Third a basic overview of the course information can be provided in the discharge packet and an nurse educator can go over the material prior to discharge. Lastly a link in the hospital website can be established allowing for access to the information presented to be accessed from home for patients and their families. In doing so this course allows for patients to adapt self-management of their CHF as well as becoming active participants in their health (Bodenheimer & Abrarnowitz, 2010).
Activities are used to help learners to progress through the course content (O'Neil, Fisher, & Newbold, 2009). For this course, I would use a combination of interactive class discussions providing patients the opportunity to share personal experiences and express areas that they may need more clarification. Using scenarios help learners to apply the knowledge and skills gained in the course to possible situations that they might encounter. Using the test questions to review content is a way for me as the instructor to gage if the students have mastered the content covered in the course material presented. Some of the group projects that would be presented in class would help to reinforce behavioral changes such as daily weight management, diet compliance with the usage of food journals, nutritional label reading, diet, exercise, etc..
When dealing with an older population of learners to much usage of multimedia can lead to a lot of distraction and take away from the content of the course. Therefore as a rule the usage of multimedia should be under the guise that less is more (O'Neil, Fisher, & Newbold, 2009). For this course I would keep it to a few charts, some animation demonstrating the blood flow trough the heart, and a few video presentations helping to establish ways to shop reading nutritional labels, diet changes, and other lifestyle changes. These presentations would be brief and short lasting less than 15 minutes and used to help introduce a topic for discussion.
By using the three click rule that is mentioned by O’Neil, the flow of information will be consistent. The three click rule basically states that the learner should be able to get to all information needed within three clicks of the mouse (O'Neil, Fisher, & Newbold, 2009, p. 91). Other ways to help learners navigate through the material is to keep the information given in short easy to understand sections keeping the type face similar as well as the page design. Placing images on the same side of the page and keeping the amount of information on each slide minimal. Placing to much information on each slide crowds the slide and makes it hard to read and understand.
In using synchronous interaction the student interacts with other members of the at the same time (O'Neil, Fisher, & Newbold, 2009). In this hybrid course this can be accomplished in several ways. They consist of face to face interaction with the nurse educator at discharge, class participation in the one hour sessions over four weeks with a group of CHF patients, and through the follow-up with the educator via telephone check ups at scheduled intervals after the complication of the program to track the students progress. Asynchronous interactions are not time dependent and for this course can be completed by the student during their own time through review of material given upon discharge, during hospital stay, and via the internet on the hospital website link to the CHF course material. Another for of interaction can be accomplished via e-mail contact with the nurse educator and posting questions on the CHF course bulletin board.
Discussion questions can be used to help students review topics covered. They can also be used to open up topics for debate and help students to share their knowledge on topics covered and share their personal experiences. If possible they should be open ended helping to stimulate student thinking and interaction (O'Neil, Fisher, & Newbold, 2009). This question allows for discussion of the signs and symptoms of when to notify the Doctor as well as gage the understanding of the students knowledge of the signs and symptoms of CHF. .
This questions allows for an open discussion on ways that patients have changed their lifestyles to improve their quality of life in living with CHF. It allows for the sharing of knowledge gained from the class as well as building on their personal experiences.
Course design for hybrid CHF class
Living with Congestive Heart Failure Judith Ketterman Walden University Intergrading Technology Into Nursing Education NURS-6320-9 December 11, 2011
Introduction: This is an course that is designed to aide in patient education on Congestive Heart Failure using theConstructivist design to enhance and create a student centered learning environment.
Target Population: Patients currently admitted to the hospital with a diagnosis of CHF. Patients that have been admitted to the hospital within the last 30 days. Family members of patients recently diagnosis with CHF.
Course Purpose: With the amount of patients being diagnosed with Congestive Heart Failure continuing to grow with an estimated 400,000 new cases each year (National Heart, Lung, and Blood Institute, 1996). The purpose for this course is to educate patients and theirfamily members on Congestive Heart failure and how to manage the disease with the goal of reducing the amount of re- hospitalizations by helping patients to have a better understanding of treatment and lifestyle changes.
Course Objectives:Objective 1: Objective 2: Patients and family Patients and family members will gain an members will learn basic understanding of how to manage CHF CHF and how it affects with medication and the body. lifestyle changes.
Course Content: Overview of CHF Treatment Lifestyle changes Prognosis When to contact a Medical Professional Preventing re-hospitalization
Course Structure: This would be presented over several class sessions in a hybrid course. Patients would receive printed copies of the power point presentation slides with additional areas for note taking. The hospital web site would also have a link to the Power point presentation. Course would be able to be accessed from inpatient rooms via the TV. Other resources such as addition websites to aide the patient in understanding CHF would be provided.
Course Activities: Interactive discussions of topics Presenting scenarios followed by discussion Multiple choice questions to review content for each section covered. Group projects in class
Course Multimedia:Usage of graphs and chartsBasic animationVideo presentations
Navigation & Page layout:Navigation: Power Point presentation presenting information covering each course section with handouts. Presentations available via hospital website link and via the hospital TV channel for inpatient educational use.Page Layout: Hospital web home page with link to course material Consistent design on power point design placement.
Interaction:Synchronous: Asynchronous: Discharge teaching Review of course Class discussions material via internet, Group Projects in class handouts, and inpatient TV. Teleconferencing Bulletin board on CHF website via hospital website link. Email access to instructor.
Discussion Question 1:Knowing the symptoms of heart failure is important in beingable to gage if your heart failure is worsening and may requirefurther treatment by your healthcare provider. Which of thefollowing changes should you notify your doctor of:a. Sudden increase in weight gain of 3 pounds in a day or 5 pounds in a week.b. A cough that does not go away.c. Irregular heartbeat (to slow or fast).d. Increase in swelling of the feet, ankles, or legs.e. All the above
Discussion Question 2: Describe one of the ways in which you have changed your lifestyle to better manage your CHF?
References:Bodenheimer, T., & Abrarnowitz, S. (2010). Helping Patients Help Themselves: How to implement self-management support. California Healthcare Foundation.Hoyt, R. E., & Bowling, L. S. (2001). Reducing Readmissions for Congestive Heart Failure. American Family Physician, 63(8), p.1593-1599.National Heart, Lung, and Blood Institute. (1996, September). Data Fact Sheet: Congestive Heart Failure in the United States. Retrieved September 12, 2011, from National Heart, Lung, and Blood Institute: http://library.thinkquest.org/27533/facts.htmlONeil, C. A., Fisher, C. A., & Newbold, S. K. (2009). Developing online learning environments in nursing education (2nd ed.). New York: Springer publishing company.Stone, J., & Hoffman, G. J. (2010). Medicare Hospital Readmissions: Issues, Policy Options and PPACA. Congressional Research Service, 1 - 37.
References cont.:U. S. National Library of Medicine and National Institutes of Health. (2011, July 22). Heart failure. Retrieved December 9, 2011, from Medline Plus: Trusted health information for you: http://www.nlm.nih.gov/medlineplus/ency/article/000158.htmUnknown. (2010, July 5). Blooms Taxonomy of Learning Domains. Retrieved September 15, 2011, from Big Dog and Little Dogs performance juxtaposition: http://www.nwlink.com/~donclark/hrd/bloom.html