Undergraduate Stroke Curriculum



Undergraduate Stroke CurriculumJennifer FernandezUniversity of Saint MaryUndergraduate Stroke CurriculumMission statementThe programs mission is to; “committed to the mission and values of the university, the mission of the nursing program is to educate students to become baccalaureate prepared nurses who value excellence, provide leadership, show caring attitudes in all endeavors, foster community and embrace life-long learning. Graduates are prepared to provide outcome focused, client centered, evidence-based, holistic nursing care to individuals, groups, and communities of diverse backgrounds” (University of Saint Mary [USM], 2014-2015, p. 191).Program goalsThe goals of our stroke course will be for the students to acquire the knowledge, critical thinking, assessment, and evaluation skills necessary to care for a stroke patient. The student will have confidence and adequate skills to assess and communicate effectively with the physician and ancillary team upon completion of the course. The student will be familiar with medications and able to communicate and educate effectively with the patient and family. They will also have the knowledge to help provide the patient with discharge teaching and rehabilitation knowledge. Evidence of course necessityStroke is one of the leading causes of death in the United States. “Every year, more than 795,000 people in the United States have a stroke” (Center for Disease Control and Prevention [CDC], 2015, para. 1). One out of four people that have had a stroke will have a recurrent stroke (CDC, 2015). With these statistics nurses need to be prepared to receive and perform evidence based practice care for each of them. It is vital to understand the difference in the two types of strokes and how to care for them. Students will need to be familiarized with the medications and treatment options. Most patients will need rehabilitation post hospitalization. The student needs to acquire the skills, critical thinking and communication to collaborate with disciplinary teams. Physical therapy and social workers will need to also be updated on patient condition and collaborate with the nurse in order to find appropriate post hospitalization placement. “Stroke is a leading cause of serious long-term disability” (CDC, 2015, para. 1).Course name and credit hours This curriculum will be intertwined with neurology teaching during the undergraduate studies. This section of neurology would be subcategorized as cerebral vascular accidents (CVA) or stroke. The name of this course will be Cerebral Vascular Accident CVA or Stroke. Due to its incorporation into the neurology teaching for the undergraduate class, this would be completed with the three credit hour medical/surgical teaching. Course descriptionThis course focuses on developing students’ knowledge and abilities to understand, compare and contrast, and describe the different types of strokes. This course will focus of the helping students acquire the skills to conduct a stroke assessment (Billings & Halstead, 2012). “The process data collection, interpretation, documentation and dissemination of assessment data will be addressed” (Billings & Halstead, 2012, Box 10-1).Course outcomesAt the end of this course the undergraduate will be able to identify the following:Describe the two different types of strokes.Identify the signs and symptoms of an acute stroke.List risk factors/predispositions to strokesList treatments for a stroke.Explain how and what type medications can do to prevent stroke and be prescribed after stroke. Explain what medication can be prescribed to prevent strokes.Explain methods of stroke rehabilitation. Teaching/learning methodsOur teaching and learning methods will include power points, discussions, case studies, simulations, written assignments, reflections, and laboratory and clinical experiences. Several forms of media will support the learning process along with readings. According to Mills et al. (2014), case studies and simulation provide an interactive and learning reflective of ‘real-world’ experience which nursing students want. Case studies are used to develop critical thinking skills, problem solving skills, and scenarios that mimic real life situations (Mills et al., 2014). Mills et al. (2014) states “additionally, this type of learning allows students to progress according to their level of knowledge (West et al., 2012) as case studies can be used at any year level in an undergraduate nursing program” (p. 12). Iwasiw & Goldenberg (2015)?list case studies, discussions, written assignments, reflective journaling, and simulations as active for student engagement; and power points and video/podcasts as passive learning (p. 308-309). Assignment example with learning objectivesThe assignment example will be a case study with questions to be answered and submitted as a written assignment.Learning objectives: Identify the type of stroke, symptoms, and treatments. Contrast the types of strokes.A fifty year old male, Alvin, presents to the emergency room with his wife mid- morning. Alvin is not sure why he is there and doesn’t understand what is going on around him. His wife reports that Alvin could not speaking clearly on the phone and was not making sense, so she called 911 and went home. Alvin answered the door. His wife noticed Alvin was not walking and moving like normal. Alvin did not realize anything was wrong and said she was being silly.On initial exam, Alvin had weakness to his left arm and hand, grip was weak, not able to hold onto a cup, his left leg was weak, yet he was able to ambulate. Vital signs were temperature of 98.6 F, pulse of 105, respirations of 28, blood pressure of 181/105. Lab work revealed total cholesterol of 300, high-density lipoprotein of 40 mg/dl, low-density lipoprotein of 160 mg/dl, triglycerides of 180 mg/dl, and glucose of 145 mg/dl, height=67”, and weight=283 lbs. All other lab values were within normal limits. Alvin is a non-smoker, has a family history of cardiac disease, but is not very active, and is not prescribed any prescribed medications.Questions: What is happening to Alvin as indicated by the lab values, vital signs, and presenting symptoms? What risk factors does Alvin have for his presenting condition? What treatment(s) would be started for Alvin and why? What are the differences between Alvin’s presenting condition and another type for her condition and the treatments?Evaluation of assignmentsEvaluation and assessment is used interchangeably even though the terms are different. Evaluation determines if the learner has progressed towards the outcomes, effectiveness of fostering learning, and accomplishment to produce graduates that are ready for entry into practice according to the mission of the school (Wittman-Price, Godshall, & Wilson, 2013). According to Wittman, Godshall, & Wilson (2013), “assessment involves setting standards and criteria for learning, gathering, analyzing, and interpreting data to determine how performance matches the standards and criteria and using that information to improve learning, teaching, courses, and programs” (p.189). The evaluation of the assignments will take place through exams, written assignments such as reflective journaling, case studies, and specific topic assignments. A grading rubric will be used to specify the criteria to meet the outcomes for an assignment (Wittman-Price, Godshall, & Wilson, 2013). The student needs to know the criteria prior to completing the assignment or munity partnershipCommunity partnerships with the local hospitals, nursing homes, medical facilities, and nursing schools need to be established to obtain clinical sites for the nursing student experiences. Nurses practicing in the facilities may serve as clinical instructors depending upon the agreement between the facility and the nursing school. According to Murray, Schappe, Kreienkamp, Loyd, & Buck (2010), “the majority of these partnerships have taken the form of a strategic alliance between an academic enterprise and a health care organization to expand faculty and student capacity” (p. 295). External constituentsThere are three basic opportunities for building an external constituency. The first step is to establish a departmental advisory board; second, provide opportunities for the department’s alumni and friends to spend time on campus, and, third, to reach a broad audience it may be necessary to “take your show on the road.” “It is important to engage in extensive planning to determine the purpose for convening a board, assessing the expectations of the department and the board members, and in explaining the strategic value of a board to some reluctant faculty” (Jones, 2014, p.1). According to Jones (2014) Peter Drucker was quoted in a 1989 Wall Street Journal article saying, “People no longer give to charity; they buy into success.” We should seek to develop the optimal relationship between institutional capabilities and values and environmental needs and opportunities. With stroke being common and a high risk, it is extremely important for learners to comprehend and engage in learning all of the outcomes. “External constituents including professors along with administration would need to be involved and fully engaged to provide the best education setting” (Kataria, Garg, & Rastogi, 2012, p. 12). According to Billings & Halstead (2012, p. 120-123) there are multiple bodies involved with external constituencies. These include but are not limited to: state boards of nursing, accrediting bodies, institutions of higher education, market forces, and organizations such as American Nursing Association (ANA), American Association of Colleges of Nursing (AACN), and American Organization of Nurse Executives (AONE). “The increase in public accountability has expanded the visibility of nursing education at the national, state, and local levels, which has ultimately involved stakeholder involvement in the education and practice of nurses” (Billings & Halstead, 2012, p. 120). This stakeholder involvement in the marketplace is where people are “buying into success.” “With state boards of nursing across the country and accrediting bodies also regulating all nursing education, it decreases the ability for creativity in instruction and increases regulated control of how the teaching occurs. With pressure to increase knowledgeable graduates but in a quicker fashion as to meet the shrinking resources the regulations stem a high level of accountability” (Billings & Halstead, 2012, p.120). These external constituents are now the regulating factors in creating nurses that have received a minimum amount of hours in differing specialties and clinical to meet acceptable standards in today’s world of nursing graduates. “Today, student academic achievement is measured against graduation rates, performance on licensure examinations, job placement rates, and program satisfaction” (Billings & Halstead, 2012, p. 121). How ongoing appraisal will continue“Ongoing appraisal is the deliberative, continuous, repeated, and careful critique of curriculum ideas, products, and processes during and after the creation, implementation, and evaluation” (Iwasiw & Goldenberg, 2015, p. 49). The section in the neurology med-surg course focusing on stroke, along with all topics taught, will need to be assessed several times throughout the year. The first appraisal will be after the coursework is written by faculty. After the coursework is approved and it begins being taught in class the next step in the appraisal process is after testing. Testing is an assessment of the students’ knowledge learned from the assigned reading and lecture material presented. Assessing how the students performed overall on the exam questions regarding the stroke education is a strong appraisal route to pursue. It needs to be assessed again after the students take the cumulative final exam. Discussions regarding students’ knowledge levels achieved regarding the new stroke education written need to be held in faculty meetings and courses of action to improve or maintain current teaching models needs to be addressed. Administration is also involved in the process as another view of critiquing the effectiveness of the new teaching process. “As curriculum development teams work together, individual members judge ideas that are proposed. The team discusses ideas, examining and informally appraising them” (Iwasiw & Goldenberg, 2015, p. 50). “Formal appraisal is essential to ensure that all aspects of the curriculum, singly and together, are unified and consistent with the curriculum intent” (Iwasiw & Goldenberg, 2015, p. 51). Figure 3-1 Ongoing Appraisal supports this depiction. How faculty involvement will be requested and initiated Faculty from all teams in the program will be requested to provide their input and knowledge skills on how to best present the educational coursework. “Assessment practitioners commonly assert that faculty involvement in the assessment process is critical to its success, though obtaining such involvement is not an easy task” (Ray, Peterson, & Mongomery, 2012, p. 85).?Faculty members have numerous demands of their time, and “evidence indicates that faculty members often prioritize assessment activities below other activities, if at all” (Ray, Peterson, & Montgomery, 2012, p. 84).?From my experience starting out with a positive energy when asking for faculty involvement, more professors are willing to assist in the course design. It may sound silly but providing snacks and beverages during the meetings may also help initiate a positive work environment. People are more likely to help when they feel needed and appreciated at the same time. Initially small meetings to go over outcomes and the desired learning from the students would be a great start. If the work environment and meetings stay positive, open, and relaxed, more faculty will be willing to continue with the project of designing the curriculum.ReferencesBillings, D. M., & Halstead, J. A. (2012). Teaching in Nursing: A Guide for Faculty (4th ed.). St. Louis, MO: Elsevier: Saunders.Center for Disease Control and Prevention. (2015). Stroke facts. Retrieved from , C.L. & Goldenberg, D. (2015).?Curriculum development in nursing education,?(3rd ed.). Burlington, MA: Jones & Bartlett Learning.Jones, G. (2014). Building External Constituencies and Departmental Fundraising. CDS. Retrieved from: Kataria, A., Garg, P., & Rastogi, R. (2012). Employee Engagement and Organizational Effectiveness: The Role of Organizational Citizenship Behavior. International Journal of Business Insights & Transformation,?6(1).McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Elsevier Mosby.Mills, J., West, C., Langtree, T., Usher, K., Henry, R., Chamberlain-Salaun, J., & Mason, M. (2014). “Putting it together”: Unfolding case studies and high-fidelity simulation in the first-year of an undergraduate nursing curriculum. Nurse Education in Practice 14, 12-17. , T. A., Schappe, A., Kreienkamp, D. E., Loyd, V., & Buck, E. (2010). A community-wide academic-service partnership to expand faculty and student capacity. Journal of Nursing Education 49 (5), 295-299. DOI: 10.3928/01484834-20100115-03Ray, C. M., Peterson, C. M., & Montgomery, D. M. (2012). Perceptions of College Faculty Concerning the Purpose of Assessment in Higher Education. Journal of Human Subjectivity,?10(1), 81-102.Thrift, A. G., Srikanth, V. K., Nelson, M. R., Kim, J., Fitzgerald, S. M., Gerraty, R. P., ... Cardilhac, D. A. (2014). Risk factor management in surviviors of stroke: A double-blind, cluster-randomized, controlled trial. International Journal of Stroke, 9, 652-657. of Saint Mary. (2014-2015). Catalog. Retrieved from , C., Usher, K., & Delany, L. (2012). Unfolding case studies in pre-registration nursing education: Lessons learned. Nurse Education Today 32 (5), 576-580.Wittman-Price, R. A., Godshall, M., & Wilson, L. (2013). Certified Nurse Educator (CNE) review manual. (2nd ed.). New York, NY: Springer. ................
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