NUR 635 Module 3 Milestone One Example

Milestone One: Learner and Needs Assessment for an Anticoagulant Safety Lesson in Second-Year Pharmacology

[Student Name]

Southern New Hampshire University

NUR 635: Teaching and Learning for Nurse Educator

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: Learner and Needs Assessment for an Anticoagulant Safety Lesson in Second-Year Pharmacology

Teaching plans often begin with content: what the textbook covers and what the exam will test. Effective teaching begins earlier, with the learners. What do they already know, what do they believe that is wrong, what experiences do they bring and what might make learning harder for some of them? This milestone assesses the learners and their needs for an anticoagulant safety lesson in a second-year pharmacology course. It argues that the students' specific misconceptions, more than gaps in knowledge, are the main obstacle to safe practice and that the teaching plan must be built to confront them.

Why Anticoagulant Safety

Anticoagulants are among the drugs most likely to harm patients. In a nationally representative surveillance study of emergency department visits for adverse drug events in 2013 and 2014, anticoagulants, antibiotics and diabetes agents together were implicated in nearly half of visits, and the share involving anticoagulants had grown since 2005 and 2006, with hemorrhage the main harm (Shehab et al., 2016). Nurses administer, monitor and teach about these drugs daily. At Harborside's clinical partner hospital last term, a second-year student nearly gave a scheduled dose of enoxaparin two hours after a patient's epidural catheter was removed; the staff nurse intervened, citing the timing required to reduce the risk of spinal hematoma. The student later said she had not known that timing rules applied. The near-miss prompted faculty to rebuild the anticoagulant lesson.

Who the Learners Are

The course enrolls 72 second-year students in a traditional baccalaureate program. Ages range from 19 to 46, with a median of 21. About 40% work part-time as nursing assistants or patient care technicians, and several have cared for family members taking warfarin. Roughly a quarter grew up speaking another language at home, and faculty report that some of these students hesitate to ask questions in large groups. Six students have documented accommodations, most commonly extended testing time. Students have completed pathophysiology, including coagulation, and one semester of clinical practice but have not yet had a medical-surgical rotation where anticoagulants are common. Many are working adults whose motivation rises when content connects directly to the patients they will soon care for, consistent with Knowles's view that adults learn best what they need for real roles (Knowles et al., 2015).

What They Already Know and Believe

A 20-item pretest, given in the week before the lesson, averaged 58%. Item analysis revealed a pattern more useful than the score. Most students knew that anticoagulants increase bleeding risk and could name warfarin and heparin. The errors clustered around four misconceptions. First, 61% matched the wrong laboratory test to the drug, most often choosing the INR to monitor unfractionated heparin rather than the aPTT or anti-Xa level. Second, 70% believed that all anticoagulants require routine laboratory monitoring, not knowing that direct oral anticoagulants generally do not. Third, 54% could not name a reversal agent for any drug, and several believed vitamin K reverses all anticoagulants. Fourth, only 22% knew that neuraxial procedures, such as epidural catheter removal, carry specific timing rules for anticoagulant doses.

How the Assessment Was Done

Four sources fed the assessment, and each answered its own question. The registrar's office provided anonymized data on age, program progression and accommodations. A voluntary online survey, completed by 61 of the 72 students, asked about work experience, caregiving, home language and how comfortable students felt asking questions in lectures versus small groups. The pretest, written by the course faculty and reviewed by a clinical pharmacist, contained 20 multiple-choice and short-answer items covering monitoring, reversal, timing and patient teaching; it was ungraded, which encouraged students to answer honestly rather than guess strategically. Finally, faculty interviewed the staff nurse involved in the near-miss and two clinical instructors about the errors they see most often. Combining these sources guards against relying on a single test score and gives a picture of both what students know and the conditions under which they learn.

Why Misconceptions Matter

Research on learning shows that prior knowledge can help or hinder new learning. When it is accurate and activated, it gives new information something to attach to; when it is inaccurate, it can distort how new information is understood, and simply presenting correct information may not displace it (Ambrose et al., 2010). A student who believes vitamin K reverses all anticoagulants may hear a lecture on specific reversal agents and remember only that vitamin K is involved. Misconceptions like these need to be surfaced and directly contrasted with correct understanding, ideally by having students make predictions that the correct information then contradicts.

Learning Needs

The assessment points to five learning needs. Students need to match each anticoagulant class to its monitoring requirements, including the absence of routine monitoring for direct oral anticoagulants. They need to identify the reversal agent or strategy for each class. They need to recognize situations requiring timing precautions, especially neuraxial procedures. They need to apply this knowledge to patient scenarios, deciding what to check and when to hold a dose and call the prescriber. And they need to teach patients about bleeding signs in plain language, drawing on the experience many already have as caregivers or nursing assistants. The plan must also make participation safe for students who hesitate to speak in large groups and provide testing accommodations for the six students who need them.

Conclusion

The 72 students entering the anticoagulant lesson know the basic risk but hold specific, confident misconceptions about monitoring, reversal and timing, the very areas where errors harm patients. They bring caregiving experience, varied language backgrounds and differing needs for accommodation. The objectives and strategies in the following milestones will be written to confront those misconceptions directly and to draw on what the students already bring.

The assessment has limits. Eleven students did not complete the survey, and they may differ from those who did. The pretest was written locally and has not been validated, so its items will themselves be reviewed after the lesson. And the near-miss is a single event; it illustrates a risk rather than proving how common the underlying misconception is. These limits argue for repeating a short knowledge check after the lesson and for treating the learning needs as a starting point that later evidence can revise.

References

Ambrose, S. A., Bridges, M. W., DiPietro, M., Lovett, M. C., & Norman, M. K. (2010). How learning works: Seven research-based principles for smart teaching. Jossey-Bass.

Knowles, M. S., Holton, E. F., III, & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development (8th ed.). Routledge.

Shehab, N., Lovegrove, M. C., Geller, A. I., Rose, K. O., Weidle, N. J., & Budnitz, D. S. (2016). US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA, 316(20), 2115-2125. https://doi.org/10.1001/jama.2016.16201