NUR 634 Module 3 Milestone One Example

Milestone One: A Proposal to Replace the Heart Failure Lecture With a Flipped, Case-Based Session in a First Medical-Surgical Course

[Student Name]

Southern New Hampshire University

NUR 634: Facilitating Learning and Teaching Innovation in Nursing Education

Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone One: A Proposal to Replace the Heart Failure Lecture With a Flipped, Case-Based Session in a First Medical-Surgical Course

Changing how a core topic is taught is a decision that affects students, faculty and a program's licensure results, and it deserves the same rigor as a clinical practice change. This milestone proposes replacing the three-hour heart failure lecture in Riverbend Community College's first medical-surgical course with a flipped, case-based session. It argues that the current approach produces factual recall without clinical application, that the evidence for flipped learning is favorable though not uniform and that a carefully scoped pilot with measurable objectives is the responsible way to test the change.

The Learning Problem

Heart failure fills medical wards with older adults and turns up again and again on the licensure examination. In the composite first medical-surgical course, 64 second-semester associate degree students receive a three-hour lecture of 96 slides. Over the past three terms, the average score on the heart failure unit exam was 74%, and item analysis shows the weakest performance on application items, those asking students to decide what a set of findings means, where the average was 61%. Clinical faculty, asked to rate students on whether they connected assessment findings such as weight change and lung sounds to fluid status, rated fewer than a third as consistently able to do so. Student course evaluations describe the lecture as "a lot to take in" and "hard to stay focused." The pattern is clear: students can recall facts about heart failure but struggle to apply them, which is the skill clinical practice and the licensure examination both require.

What the Evidence Shows

The flipped classroom moves the transmission of content outside class, through readings or videos, and uses class time for active application. Its evidence base in health professions is growing. A meta-analysis of 28 comparative studies in health professions education found a significant overall improvement in learning outcomes with flipped classrooms compared with traditional teaching, with a modest effect size (Hew & Lo, 2018). The evidence in nursing specifically is more mixed. A systematic review of flipped classrooms in nursing programs found neutral or positive academic outcomes and mixed student satisfaction, and its authors observed that engagement improved where teachers took time to justify the change to their students; not one included study examined the implementation process itself (Betihavas et al., 2016). Evidence from other fields reinforces the broader principle: Freeman's pooled analysis of undergraduate STEM courses showed higher exam scores and fewer failures under active learning than under lecture (Freeman et al., 2014).

Read together, these findings support trying a flipped approach but caution against expecting large gains or universal student enthusiasm. They also point to two design lessons: explain the model to students before starting, and plan to evaluate the implementation, not only the outcomes.

The Proposed Innovation

The heart failure topic would be restructured in two parts. Before class, students would watch three short videos totaling about 25 minutes on the physiology of heart failure, its classification and its drug treatment, read a 12-page text section and complete a 10-question online quiz with immediate feedback. In class, the three hours would be devoted to an unfolding case of a 70-year-old man admitted with worsening heart failure, presented in four segments that follow the phases of clinical judgment: noticing cues in admission data, interpreting what they mean, deciding on nursing actions and reflecting on the patient's response to treatment. Students would work in groups of four, with faculty circulating and a brief whole-class discussion after each segment. A short lecture segment of no more than 15 minutes would remain available to address misconceptions identified in the pre-class quiz.

Objectives

The session would have four learning objectives, each to be assessed. The four objectives ask students to identify cues of fluid overload in a patient's data, including weight, lung sounds, edema and jugular venous distension, to interpret those cues to distinguish worsening heart failure from other causes of dyspnea, to select and justify priority nursing actions and to evaluate a patient's response to diuretic therapy using objective measures. Program-level objectives would be a rise in the average score on heart failure application items from 61% to at least 70% and an increase in the proportion of students rated by clinical faculty as consistently connecting findings to fluid status from under a third to at least half.

Scope and Feasibility

The proposal is limited to one topic in one course for one term, with the other sections of the course unchanged. It requires faculty time to record videos and write the unfolding case, estimated at 30 hours, and a room where groups can work together. The course coordinator and two clinical faculty have agreed to take part. A contingency plan covers the risk that many students arrive unprepared: the first 10 minutes of class will include a short readiness quiz, and students who score poorly will spend the first case segment with a faculty member reviewing the key concepts before joining their groups. Because the pilot runs in one term only, the traditional lecture slides will be kept available so the course can revert if the pilot must be stopped. Students would be told in the first week why the heart failure session is taught differently and what preparation is expected, following the review's finding that explaining the model improves engagement.

Questions for the Design Milestone

Milestone Two will need to answer four questions. What content belongs in the pre-class materials, and how will unprepared students be handled in class? How will the unfolding case be written so each segment tests a specific objective? How will assessment items be aligned with the objectives? And how will faculty be prepared to facilitate rather than lecture?

Conclusion

Riverbend's heart failure lecture produces recall without application, as the exam data and clinical ratings show. The evidence for flipped learning is favorable, if not uniform, and suggests clear design lessons. A scoped pilot with measurable objectives offers a responsible test of whether moving content outside class and practicing clinical judgment in class helps students do what nursing requires.

References

Betihavas, V., Bridgman, H., Kornhaber, R., & Cross, M. (2016). The evidence for 'flipping out': A systematic review of the flipped classroom in nursing education. Nurse Education Today, 38, 15-21. https://doi.org/10.1016/j.nedt.2015.12.010

Freeman, S., Eddy, S. L., McDonough, M., Smith, M. K., Okoroafor, N., Jordt, H., & Wenderoth, M. P. (2014). Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences, 111(23), 8410-8415. https://doi.org/10.1073/pnas.1319030111

Hew, K. F., & Lo, C. K. (2018). Flipped classroom improves student learning in health professions education: A meta-analysis. BMC Medical Education, 18, Article 38. https://doi.org/10.1186/s12909-018-1144-z