NUR 634 Module 9 Final Project Example

Final Project: A Teaching Innovation Proposal to Build Clinical Judgment in Heart Failure Through a Flipped, Case-Based Session

[Student Name]

Southern New Hampshire University

NUR 634: Facilitating Learning and Teaching Innovation in Nursing Education

Final Project

[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.

Final Project: A Teaching Innovation Proposal to Build Clinical Judgment in Heart Failure Through a Flipped, Case-Based Session

Nursing programs are judged by whether their graduates can think clinically, yet much of their teaching still rewards recall. This proposal asks Riverbend Community College's curriculum committee to approve a one-term pilot that changes how one core topic, heart failure, is taught in the first medical-surgical course. It brings together the problem identified in the course's own data, the evidence from education research, the framework that shaped the design, the materials built for the session, the plan for carrying it out and the evaluation that will decide its future. It argues that a carefully designed flipped session, focused on clinical judgment and evaluated honestly, is a responsible step toward teaching students to do what nursing requires.

The Gap Between Knowing and Doing

For three years the course has taught heart failure through a single three-hour lecture of nearly 100 slides. The unit exam average across that period was 74%, but performance on the eight items requiring students to interpret a set of findings averaged only 61%. Clinical faculty, asked whether students consistently connected changes such as weight gain and new crackles to fluid status, said yes for fewer than a third. Students' own comments describe the lecture as overwhelming. The data describe students who can recite the signs of heart failure but struggle to recognize them in a patient, which is the gap the proposal addresses.

Weighing the Evidence

The case for changing the method rests on three bodies of evidence. First, across 225 studies of undergraduate science and mathematics courses, active learning raised exam performance and lowered failure rates relative to lecture (Freeman et al., 2014). Second, in health professions education, pooled results from 28 comparative studies favored flipped classrooms over traditional teaching, with a modest effect (Hew & Lo, 2018). Third, and more cautiously, the systematic review focused on nursing programs reported academic outcomes that were neutral or positive and satisfaction that was mixed, with better engagement where faculty explained the approach (Betihavas et al., 2016). The evidence therefore supports trying the method while warning against promising large gains, and it shapes two design choices: explaining the model to students in advance and evaluating how the pilot is carried out as well as its outcomes.

The Framework Behind the Design

The session is organized around Tanner's model of clinical judgment, which describes how nurses notice what matters, interpret its meaning, respond with action and reflect on the outcome, and which holds that these capacities grow through practice and reflection rather than instruction alone (Tanner, 2006). Each part of the in-class case is built to exercise one phase. Assessment in clinical uses the Lasater clinical judgment rubric, developed from Tanner's model, which lets faculty give feedback in the same language students practiced in class (Lasater, 2007). The design also follows the principle of constructive alignment, in which outcomes, learning activities and assessment tasks are built to match (Biggs, 1996).

The Session

Before class, students complete three narrated videos of five to seven minutes each, on the physiology, classification and drug treatment of heart failure, a short reading and a 10-question online quiz. The quiz results show faculty which concepts need a brief review at the start of class. In class, groups of four follow Mr. D., the retired carpenter of the case, through four released segments. In the first, they pick out the findings that matter from his morning data. In the second, new information, including his admission that he stopped taking his diuretic, lets them decide what is happening. In the third, they choose nursing actions and prepare a call to the provider. In the fourth, they judge his response the next day and spot a new problem, a low potassium. Faculty circulate with scripted questions and hold a short class discussion after each segment.

Aligned Objectives and Assessment

Four objectives guide the session: identifying cues of fluid overload, interpreting them as worsening heart failure, selecting and justifying priority actions and evaluating the response to diuretic therapy. Each is matched to pre-class material, an in-class segment and specific exam items, and the call to the provider is also rated in clinical. Program targets are an average of at least 70% on the application items and at least half of students rated at the developing level or higher on the three most relevant rubric dimensions.

Making It Work

Three practical measures protect the pilot. A short readiness check at the start of class routes anyone who skipped the preparation to a short review with an instructor before the first case segment. Two clinical faculty will rehearse the case and the scripted questions with the course coordinator before the session and meet afterward to revise it. Every video carries captions and a transcript and plays on a phone, and materials are posted a week in advance for students who work or care for family. Preparation will take about 30 faculty hours, most of which will not recur in later terms.

Evaluation

The pilot will be evaluated at four levels following Kirkpatrick: student reaction through a brief survey, learning through the application items compared with the previous three cohorts, clinical behavior through calibrated Lasater ratings compared with the previous cohort and results through later course and program indicators interpreted cautiously (Kirkpatrick & Kirkpatrick, 2006). Exam items will be checked for difficulty and discrimination before results are read. Threats to validity, including cohort differences and the enthusiasm that surrounds any new approach, are acknowledged, and the pilot will be repeated if results are promising.

What the Committee Is Asked to Approve

Three approvals are requested: the one-term pilot of the flipped heart failure session in the first medical-surgical course; the replacement of the written care plan on the following clinical day with the structured clinical judgment reflection; and a decision rule under which the approach is extended to a second topic if the learning and behavior targets are met, revised if learning improves but students report serious workload problems and discontinued if neither learning nor clinical judgment improves.

Conclusion

The course's own data show students who know about heart failure but cannot yet recognize it in a patient. Education research supports a change in method, though not an exaggerated promise. A flipped session built on Tanner's model, aligned with assessment, carefully implemented and honestly evaluated gives Riverbend a sound way to test whether teaching clinical judgment on purpose produces nurses who can use it.

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

Biggs, J. (1996). Enhancing teaching through constructive alignment. Higher Education, 32(3), 347-364. https://doi.org/10.1007/BF00138871

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

Kirkpatrick, D. L., & Kirkpatrick, J. D. (2006). Evaluating training programs: The four levels (3rd ed.). Berrett-Koehler.

Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04

Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211. https://doi.org/10.3928/01484834-20060601-04