Behind The Design: Principles of DNP Anesthesia Practice II

Custom Course Redesign

Teaching DNP nurse anesthesia students to identify and manage co-existing diseases that impact anesthesia care.

Challenge and Opportunity

Project

Complete redesign of Master of Science course Advanced Principles of Anesthesia II to newly approved Doctor of Nursing Practice course Principles of DNP Anesthesia Practice II.

Project Background

Analysis

In 2020, the nurse anesthesia program at Arkansas State University was approved to become a doctoral-level nurse anesthesia program. Because of this, all courses within the program would need to be evaluated and redesigned to meet the newly approved standards and criteria. This project was a request for a complete redesign of the Master of Science course NURS 6543: Advanced Principles of Anesthesia II to a Doctor of Nursing Practice course NURS 8444: Principles of DNP Anesthesia Practice II.

A course walk-through video of this entire project can be requested via email. In the video, I walk through the course redesign project, talk about the importance of analysis, and the use of frameworks to anchor learning. I also talk through several key strategies used in the design or the course.

The primary faculty member (collaborator) for this project provided the following documents for review:

Curriculums for both the existing masters level program and the new doctorate level program
Course syllabus outline for the project course (generic)
Existing course syllabus for the old course (master’s level version)
Course syllabi (previous and new) for the other Principles of Nurse Anesthesia Practice courses (I and III).
Textbooks (3) that were required for this course and would be used/refenced for creating content.

Learners and Contexts

The learners in this course would be in Year 1, Semester 3 of the Doctor of Nurse Practice (DNP) in Nurse Anesthesia program.
The course would take place in the Spring semester of 2022.
The course would be delivered using online learning materials and tasks, with face-to-face lectures.
There was the potential for the course to be converted to online if pandemic restrictions prevented face-to-face lectures.
The learners would all be registered nurses with extensive intensive care experience who applied, completed a rigorous application and interview process, and were chosen to be in the program.
No learner interviews were completed for this project since it was being completed far in advance of its opening.
Discussions with the course instructor found that the typical characteristics of students in this program were that they are highly motivated, ambitious, achievement driven, and focused.
Another important characteristic for learners in this group is their desire to have learning activities that are relevant and aligned with the real world setting.
Since these particular students were coming from years of experience in the healthcare setting already, they placed a heavy emphasis and expectation on learning that aligns with what they knew to be realistic and necessary in that practice environment.

Instructional Content

The content of this course would be derived primarily from 3 different textbooks, with additional materials to be selected by the instructor if needed to support student learning and comprehension.

The textbooks provided were:

Stoelting’s Anesthesia and Co-existing Disease (6th edition), by Hines and Marschall.
Morgan & Mikhail’s Clinical Anesthesiology (5th edition), by Butterworth, Mackay, and Wasnick.
Clinical anesthesia (7th edition), by Barash, Cullen, and Stoelting.

Instructional Goal(s)

According to the newly approved syllabus, the student learning outcomes for this course would be:

Formulate therapeutic interventions for patients throughout the perioperative continuum in relation to their physical status, anesthesia, surgical, and diagnostic care.
Analyze potential perioperative outcomes specific to the patient’s physical status, surgical, or diagnostic interventions, and methods of anesthesia delivery.
Compare team and leadership behaviors throughout the perioperative experience.
Propose health promotion interventions and nurse anesthesia management strategies for maintaining homeostasis and improving patient outcomes.

Based on these student learning outcomes, an initial draft of a broad instructional goal was developed:

The DNP anesthesia student will use basic sciences, evidence-based practices, and safety and quality conceptual frameworks to determine appropriate anesthesia care management for patients in the perioperative setting.

**During subsequent discussions with the primary instructor, additional information, important terminology, and key concepts for anesthesia care were clarified and discussed.**

It was clarified that the “perioperative setting” included not only what was taking place during surgical procedures but also the distinct phases that take place before and after surgical procedures. Therefore, creating an anesthesia care management plan would include activities in all three stages (or periods) of patient care.

It was clarified that “perioperative”, the phrase used in the course description, should be understood to include the ward admission, the anesthesia, the surgical procedures, the surgery, and the post-surgical recovery period.
It was discovered, through a “day-in-the-life” discussion, that instructors in the program (and nurse anesthetists in practice) situate their work in a framework referred to as the “7 phases of anesthesia”. This framework includes all phases that a nurse anesthetist must complete to properly manage patient anesthesia. Therefore, it was determined that it would be important to incorporate this framework as the tool upon which students would achieve the course goal and objectives.
It was stressed that in order for a student to learn how to create an anesthesia care management plan, it was essential for them to understand that perioperative and postoperative plans are based on a thorough preoperative evaluation. Therefore, students would need to have a firm grasp on the knowledge (sciences, evidence-based practices, and frameworks), skills, attitudes, and activities that take place during this preoperative period.
The key takeaway here was that the preoperative period is considered to be the basis for the entire anesthesia care management plan. This new understanding helped shape the refined goal for this course. It became important to acknowledge that for this course, as in the real life context, the preoperative period is where the anesthetist first becomes aware of coexisting diseases and conditions and begins to consider how these will affect their anesthesia care management plan.

Clarified Instructional Goal Statement

Based on the student learning outcomes and the above discussions with the primary instructor, the following clarified instructional goal statement was created:

The DNP nurse anesthesia student will develop anesthesia care management plans that demonstrate their understanding of how selected co-existing diseases impact anesthesia management and potential patient outcomes. The student’s plan will include specific details and considerations for pre, peri, and postoperative phases (which encompasses all 7 phases of anesthesia).

Unique (Custom) Solution

Design & Development, & Implementation (approach)

A unique, custom course was designed.

The course was broken down over 17 weeks (a full-length academic semester), which consisted of:

12 weeks of combined online and face-to-face learning
additional weeks allotted for Spring Break
final exam review
student presentations
independent study
the final exam

Course Structure (frameworks)

To achieve alignment between the new DNP standards, the newly outlined student learning outcomes, the newly refined course goal, the incorporation of the 7 phases of anesthesia, and any other key understandings discovered during analysis, the course was structured around the following:

➤ A 5-stage process for identifying conditions that could impact anesthesia, allowing for targeted management. The stages were as follows:

Perform a pre-op evaluation
Identify medical condition(s) that could impact anesthesia delivery
List possible clinical manifestations of condition
Explain how condition impacts anesthesia
Develop an anesthesia management plan

➤ Progressive, weekly incorporation of the 7 phases of anesthesia:

Pre-hospital
Pre-op
Induction
Maintenance
Emergence
PACU/ICU “recovery”
Post-op

➤ The use of a conditions-implication-management table to be used by students each week to help them organize all specified conditions by listing the condition’s potential clinical manifestations, the anesthetic implications, and the corresponding anesthesia management.

The table included three essential components and prompts:

Key conditions/diseases
Effects on anesthesia and mgt plan
Plan for anesthesia for patients with the identified condition/disease

See the Sample Course Structure Table By Clicking The Button Below:

Learning Levels (categories of learning)

To determine the diseases (co-existing diseases) that would need to be included in the course and to determine the degree of depth in which each disease would need to be learned (learning category), each disease was listed and reviewed.
A starring system was used to represent the level of importance (priority) and depth desired for each condition.
This starring system (designation) would guide the design of the instruction - with conditions with low stars being assigned lower levels of learning categories (according to Bloom’s taxonomy).
This method was used since the instructor was not familiar with categories/domains of learning but could easily assign importance via assignment of stars.

Teaching Strategy

The learning content for this course would be delivered both online and through face-to-face lectures. Face-to-face lectures would take place every Monday and last approximately three hours. The online component would have various readings, learning activities, and application assignments.
Discussions with the primary instructor revealed that she preferred that in-person lecture time be used for reviewing, discussing, and further applying weekly content that students would have already covered in the online component of the course.
She felt this would make lecture time more effective for students.
With this in mind, the course content was designed with a flipped classroom approach.
Students were provided with engaging, relevant, and meaningful online learning activities that had to be completed prior to their in-person lectures.
These online activities would require active engagement with, and application of, new knowledge and skills.
This approach would require students to be active participants in their learning and would allow the instructor the ability to use each Monday’s lecture time to dive deeper into course materials, clarify any misunderstandings, reinforce learning through various in-class learning activities, and promote further application of what had been learned online.
This approach would also provide an opportunity for students to collaborate with their peers and receive real time guidance and feedback.
The instructor felt that this was a more effective strategy than lecturing on content that students had not yet had a chance to cover/study.

Course Outline (Weekly Schedule)

The course was distributed over 17 weeks. The breakdown was as follows: 12 weeks of face-to-face lecture and online content, one week for Spring break, two weeks for final exam review through student presentations, one week of independent study, and one week for the final exam.

Weekly lesson plans were created for each week of the course. A consistent format for each week’s plan was created. This would provide consistency, as well as ensure the alignment of the selected phase or clinical focus and high-priority topics/conditions with corresponding readings, objectives, and corresponding learning activities. The lesson plans include plans for both online and lecture activities. **Detailed weekly lesson plans (documents) were provided to the instructor and are owned by and only available through direct inquiry and permission from the instructor.

Detailed Course Schedule

A Detailed Course Schedule of Topics and Learning Activities can be requested via email request.

Weekly Lesson Plan Layout

The instructor was provided with a generic template to use at her discretion, which indicates the consistent format of each week. The weekly lesson plan layout can be requested via email request.

Alignment Worksheet (Learning Strategies Worksheet)

The instructor was also provided with a special table that shows each week’s phase or clinical focus, high-priority topic(s), and corresponding learning activities (both for online and lecture). This table would be another way to help the instructor see the direct connection between course content and learning activities. The Learning Strategies Worksheet can be requested via email request.

Learning and instructional strategies

The following are key strategies that were used to promote learning in the course:

Since the overall goal of the course was for learners to be able to identify conditions that could impact anesthesia and then be able to develop anesthesia management plans that address these conditions, a special table was created. This table, labeled the “Conditions-Implications-Management Table” would be used by the students each week to help them organize all specified conditions by listing the condition’s potential clinical manifestations, the anesthetic implications, and the corresponding anesthesia management.
This table would help students meet the goal of the course by organizing conditions alongside their clinical manifestations and corresponding plans. This template would also serve as a study guide for quizzes and tests. Also, by having students fill in this table as they study, it was felt that this would help students connect content in a meaningful way and prepare them to actively participate in lecture discussions and activities.
Since this program uses the 7 phases of anesthesia framework, it was decided that this course would incorporate the various phases, in a progressive manner, with each new week’s content. Therefore, each week a specific phase or phases was selected for students to focus on.
In addition to selecting a stage of anesthesia or clinical focus, each week specified conditions were selected as “high-priority” topics and used as the target for assigned learning activities (both online and in-lecture). As stated above, deliberate effort was taken to assign priority levels for every topic for the course. High-priority topics were used to build assignments that would have higher levels of learning outcomes (such as developing plans, creating concept maps, explaining a critical process, etc). Lower priority topics would be assessed through lower level assessments, such as multiple choice tests or matching quizzes.
The culminating assignment for this course was designed to bring together all of the elements of the course content and to provide evidence of the students’ ability to meet all of the objectives of the course and to meet all of the student learning outcomes. Throughout the semester, as outlined above, the students were progressively taken through all phases of anesthesia. They were also challenged to develop various plans related to managing anesthesia.
This course was designed around the concept of active learning. Active learning means that students are reading, writing, discussing content, and engaged in solving problems. Active learning involves higher order learning tasks. Each week, the learning activities in the course were deliberately designed to ensure that the students were required to learn in an active (not passive) manner. Various learning activities were selected (see Learning Strategies & Activities Worksheet)
Throughout the semester, the students are strategically engaged in activities that promote exploration, discussion, and meaningful construction of concepts and their relationships. The activities are purposefully situated in real-world contexts and require that new knowledge and skills be applied to real-world problems in a real-world (authentic) context.
John Keller’s ARCS model of motivation was intentionally incorporated into the design of the course. ARCS, standing for attention, relevance, confidence, and satisfaction was incorporated in the following way:
Attention: Lectures are started with student presentations and interaction. This was used to engage students and gain/sustain their attention.
Relevance: Each week, students are assigned authentic activities that are relevant to the role they will perform as nurse anesthetists.
Confidence: Throughout the various learning activities (both online and in-person), students are provided with guidance and support, as well as activities that are challenging, yet doable. This promotes confidence in their learning.
Satisfaction: Throughout the course, students are guided through challenging, relevant content. Upon completion of the course, the students will have learned valuable and relevant knowledge, attitudes, and skills that will help them achieve their professional goals of becoming nurse anesthetists. This meets the criteria of satisfaction.
Each week, the students are taken through all 9 events of instruction, as defined by Robert Gagné (educational psychologist who researched and developed the “conditions on learning”).
- Gain attention: Attention is gained through challenging assignments and peer interaction.
- Inform learners of objectives: Each week, learners are provided objectives for online and lecture activities.
- Stimulate recall: Each week, students are progressively building off of prior knowledge. During lectures, students are asked to present and discuss online learning activities prior to going deeper into these topics during lecture.
- Present the content: Each week, new, relevant content is presented in a consistent, organized manner.
- Provide guidance: Each week, students are provided with a course schedule, a learning unit with specific details of assignments, and guided lecture activities.
- Elicit performance: Each week, students are required to actively apply new knowledge to challenging learning activities both for online and lecture activities.
- Provide feedback: Each week, both- instructors and peers provide feedback online and in-lecture.
- Assess performance: Each week, students' performance is assessed in multiple ways: through learning assignments, in class presentations, and in-class discussions.
- Enhance transfer: Throughout the course, transfer is enhanced through repetition and selection of authentic learning tasks that are relevant to the real world practice environment.

Conclusion

This Design Document is the narrative summary of the entire design and development process and demonstrates how the project goal and expected outcomes were achieved.

This document includes the most up-to-date version of the course materials, per the original project goal and completion date. Changes are expected during the implementation phase, and typically involve necessary revisions.

Summative evaluations following compilations of a course are always recommended. This is often dictated by the institution; however, it is recommended that an instructor utilize additional evaluation models to devise a more personalized approach to evaluate their student’s experience and learning from their course. Quality assurance frameworks such as Quality Matters may also be used as a helpful formative and/or summative evaluation rubric.

All course documents “deliverables” were placed in a Google drive folder and shared with the instructor. The title of this folder is Principles of DNP Anesthesia II: NURS 8444.

Reach out to me to request a full video walk-through of this project, plus all downloadable documents mentioned.