Project: Redesign, Develop, and Teach “FNP Clinical Management I”
Custom Course Redesign & Facilitation
Teaching future Family Nurse Practitioners (FNPs) how to accurately diagnose and effectively manage pediatric patients in the outpatient clinical setting.
Challenge and Opportunity
Project
Redesign, Develop, and Teach NURS 6513: FNP Clinical Management I (Pediatric Portion), a core course in the Family Nurse Practitioner program at Arkansas State University.
Project Background
Analysis
FNP Clinical Management I is a required course for Family Nurse Practitioner (FNP) students at Arkansas State University. This request was for Summer 2020. The course would be fully online and would be divided into two 5-week sections: five weeks of women’s health content and five weeks of pediatric content.
I was asked to teach the pediatric portion of the course. However, in discussions and in reviewing the existing course content, it became apparent that a redesign was necessary.
In reviewing the previous course syllabus and course schedule, it was noted that the course consisted of having students read 9-10 chapters per week, followed by a test over these chapters. The course also included one homework assignment and a final exam. The homework assignment was based on a previous criticism that the course/program did not include cases and/or learning around dental disorders. Therefore, the one homework assignment was a dental case workup.
Learners and Contexts
Learners in this course would be registered nurses who were students in the Family Nurse Practitioner program. The students were taking courses as part of the didactic portion of the program and had not yet started their clinical rotations. Therefore, the students had no prior experience independently diagnosing and/or managing pediatric patients. Through their experiences as nurses (which varies widely in these programs), they would have some prior knowledge of collecting patient histories; however, the interviewing process and patient care focus for nurses varies from that of an FNP, varying in its purpose, depth, and approach.
The course would need to be provided fully online, over five weeks, and would include once a week synchronous meetings. Due to the general nature of their NP track (family practice), the students’ eventual working context would vary greatly. However, this course would focus on management of pediatric patients in clinic-based settings.
Instructional Content
The course textbook would be Burns’ Pediatric Primary Care (7th edition) and contained a large number of chapters, covering a wide range of topics. These topics included genetic and environmental considerations, growth and development stages, gender identity, immunizations, prescribing practices, and a large list of potential medical disorders in children. Additional content could also be used as determined by the instructor (myself).
The course outcomes were reviewed and grouped into three main categories:
Ethical, legal, and professional (Outcome 1)
Health promotion and education (Outcomes 2-4)
Clinical management (Outcomes 5-12)
Instructional Goal
Based on the student learning outcomes, analysis of the learners, and review of the provided content, the overarching goal for the course would be for the FNP student to be able to accurately manage a pediatric patient in the primary care setting. The FNP student would be able to, through a comprehensive history and physical examination, recognize the current stage of growth and development, identify key variables that affect diagnosis and treatment (such as immunizations, gender, etc), and develop a plan to properly manage their care.
Unique (Custom) Solution
Design & Development, & Implementation (approach)
A unique, fully custom course was designed (and taught).
Course Structure (frameworks)
In consideration of the learners’ prior knowledge level, the time allotted for the course, the overarching goal for the course, the need for structured approaches to diagnosing and managing patients, and the course content, an intentional strategy was chosen. The course would be structured around the following:
The stages of pediatric growth and development
Common (most likely) conditions or issues that present during the different stages of growth and development (to help situate their learning)
A structured approach to history-taking (H&P template and process) with unit-specific case studies.
Course Outline
A review of all textbook chapters was completed. Each week, specific content (and concepts) from specific chapters of the text were selected and assigned. Careful attention was given to selecting specific chapters, pages, and content for each week. These determinations were based on creating a logical sequence for the learners, building on progressive stages of growth and development, and providing directed case studies and other learning activities that would facilitate learning deeper. This would help focus the students’ attention on key items for that week and provide them an opportunity to engage with these key concepts on a deeper level (quality vs quantity).
The course outline was as follows:
Week 1: Chapters 2,6,25,26,28 (select pages and/or specific content)
Week 2: Chapters 8,9,10,16,17,18,22 (select pages and/or specific content)
Week 3: Chapters 11,12,31,34 (select pages and/or specific content)
Week 5: Chapters 40,41 (select pages and/or specific content)
**The detailed course outline (with assigned readings, learning activities, and assessments) can be requested via email.
Teaching Strategies
The students in this course, as previously stated, were nurses who were studying to become Family Nurse Practitioners. The students had not yet started their hands-on clinical learning rotations. Therefore, it was assumed that students would not yet have experience in systematically interviewing patients for the purpose of making the initial diagnosis.
Personal experience teaching NP students had revealed that registered nurses often lacked a systematic, thorough approach to developing differentials. They typically resorted to nursing approaches, which are not intended to fully diagnose and manage.
Common mistakes included not asking enough questions, resorting to memorized hospital protocols or computer-based charting templates, and making assumptions and treatment plans without proper evidence and/or support for their decisions.
Therefore, a high-priority task for this course was to first teach students a structured approach to taking a history, which would then provide the critical basis for all of the subsequent aspects of patient care.
In addition, the textbook provided a high volume of potential topics for the students to cover. In the past, the students were assigned 9-10 chapters to read (in their entirety) and then were given a test on these chapters. This teaching strategy was felt to be in conflict with what is known about deeper, more meaningful learning experiences.
Therefore, specific chapters and specific key concepts were identified, learning levels were chosen, and learning activities were created that aligned with these decisions.
Again, a heavy emphasis was placed on having the students learn and utilize a systematic, structured, thorough approach to history-taking and physical exam - as this would be an essential and critical skill throughout the rest of their careers.
Additional Considerations & Key Takeaways
Assignment of multiple, complex chapters weekly with assessments was not felt to be a high-quality or meaningful learning experience for the students. A great amount of time and care was taken to review the required student learning outcomes and to determine a clear goal for the course. In turn, the course was structured in a way that would allow for a more narrowed scope of content that could be learned in greater depth and in a more logical and progressive sequence.
A key strategy for these students was the early introduction of the history and physical template (H&P). This template, demonstrated in a video, was essential in providing the students with a strategic process for taking an adequate history. The history is one of the most critical first steps in managing patient care. The realization that nurses do not approach patient histories in the same manner as providers was an essential concept. Without first guiding students through a proper process for gaining key history components, the students would be unable to successfully achieve the goals of managing patients.
Assignments, assessments, and learning activities were chosen in a deliberate manner to ensure alignment throughout the course.
Repetitive practice in using evidence-based resources was intentionally built into the course throughout the five weeks. This is standard practice; however, this was also based on personal experience of teaching nurse practitioners students. Nurses training to be NPs often resort to making decisions based on their specific hospital protocols or based on what they have seen other providers do - instead of using evidenced-based resources for their own individual decision-making. Therefore, throughout the course, different sources of evidence were provided and students were asked to provide support for their decisions based on these high-quality and evidence-based resources.
The course learning emphasis was quality over quantity with an emphasis on learning the proper processes for diagnosing and treating patients. Therefore, course topics and activities were chosen with depth in mind versus superficial, high-volume coverage.
Action item lists were used at the beginning of each new module to help focus student’s attention on key learning tasks for that week.
Weekly Zoom class meetings started with a review of what had been covered in the previous week (recall of prior knowledge) prior to moving on to the current week’s content. This was intentional. It was an intentional strategy used to help students connect what had been learned with what would be learned in the current week.
