NUR 645 Module 7 Milestone Three Example

Milestone Three: Leveling and Designing a Community and Population Health Course Within a Revised Curriculum

[Student Name]

Southern New Hampshire University

NUR 645: Curriculum Design in Nursing

Module Seven Milestone Three

[Instructor Name]

[Date]

Milestone Three: Leveling and Designing a Community and Population Health Course Within a Revised Curriculum

A well-designed course can still fail a curriculum if it does not fit what comes before and after it. Cedar Valley's former community health course was taught well by committed faculty, yet students experienced it as a detour, because nothing earlier prepared them for it and nothing later built on it. The revised curriculum map now places population health across the program: first met in Adult Health I, where discharge cases raise social needs, then reinforced and assessed in the community course and assessed again in the capstone. This milestone redesigns the semester-five course to fill that role. It argues that a course should be designed from its position in the map, with outcomes leveled to what students already know and summative evidence that directly serves a program outcome.

Leveling the Course Outcomes

Krathwohl (2002) describes the revised taxonomy of educational objectives, which arranges six cognitive processes in rising complexity, with creating at the top and remembering at the base, and separates them from the type of knowledge involved. The taxonomy is useful for leveling because it makes the expected depth of each outcome explicit. By semester five, Cedar Valley students have met social needs screening and discharge planning at the applying level in Adult Health I. The community course therefore sets its outcomes higher. Students will analyze how social and structural conditions shape the health of a defined community; evaluate community health data and existing resources to identify priority needs; create an evidence-based intervention proposal with a community partner; and evaluate their own assumptions about the community and its members through structured reflection. None of the four outcomes asks students only to describe or list, since those levels were addressed earlier.

Designing Backward

Using the three stages Wiggins and McTighe (2005) describe, the course was designed in three stages. The desired results are the four outcomes above, framed around one enduring understanding: the health of a community is shaped more by the conditions in which people live than by the care delivered in hospitals. The evidence of those results is a signature assessment, described below, supported by smaller formative tasks. Only then were learning experiences chosen, each justified by what it contributes to the signature assessment. Two former assignments, a report on a communicable disease and a poster on a national health campaign, were removed because they did not contribute evidence toward any course outcome.

Content Framed by the Causes of the Causes

Braveman and Gottlieb (2014) pulled together decades of research to argue that health is shaped by upstream conditions, such as income, education, neighborhood and working conditions, and by the policies that shape those conditions, and that these "causes of the causes" operate through pathways including chronic stress, health behaviors and access to resources. This framing organizes the course content. Early weeks examine how income, housing, transportation and rural geography affect health in the region; middle weeks address epidemiology and community assessment methods; later weeks focus on interventions at the individual, community and policy levels. The framing also counters a tendency the needs assessment identified in students' earlier work, where social needs were treated as individual problems to be solved with a referral rather than as conditions with structural causes.

The Signature Assessment

Each clinical group of eight students is paired with a partner agency in a rural county, such as a federally qualified health center, a county health department or a school district. Over the semester, the group completes a community health assessment using public data, a windshield survey and interviews with at least three community members or leaders, identifies a priority need with the partner and writes a proposal for an evidence-based intervention the partner could realistically implement. The proposal is presented to the partner at the end of the semester. The assessment is scored with an analytic rubric that includes criteria for use of data, analysis of structural causes, strength of evidence for the intervention, feasibility and partnership. Individual accountability comes from each student's written analysis of one determinant and a final reflection.

Aligning Assessments With Outcomes

Table 1 shows that each assessment serves a course outcome and a program outcome. The intervention proposal is the summative evidence for population health that the curriculum map requires in this course. Group work is balanced by individual components so that each student's grade reflects their own contribution.

Table 1. Alignment of Course Assessments With Course and Program Outcomes

Note. Every graded assessment serves at least one course outcome and one program outcome; the intervention proposal provides the summative evidence for population health marked on the curriculum map.

Clinical Hours and Partners

The course's 90 clinical hours are spent mostly with the partner agency and in related community settings, such as school health rooms, mobile clinics and home visits with public health nurses. Partners were recruited through the advisory board, and each signed an agreement describing what students will provide and what partners will offer. Partners valued the chance to receive a community assessment and proposal they could use for grant applications, which gives the relationship lasting value beyond the semester. Faculty supervise at a distance and meet each group weekly.

Preparing Students and Faculty

Students arrive in semester five with little experience of community work, and many have grown up in suburban areas unlike the rural counties where they will be placed. The first two weeks therefore include an orientation with each partner agency, a guided windshield survey with the clinical instructor and a first reflective journal on what students expect to find. Faculty preparation matters as much. Only two Cedar Valley faculty have community health expertise, so they will co-teach the first offering with two medical-surgical faculty who will lead clinical groups in later terms, sharing materials, rubrics and weekly debriefs so that the course does not depend on two people.

Conclusion

The redesigned course fits its place in the curriculum: outcomes leveled above what students met in Adult Health I, a design built backward from a signature assessment, content framed by the causes of the causes and every graded task aligned with a course and program outcome. Students who reach the capstone will have introduced, practiced and demonstrated population health, and the course will no longer feel like a detour.

References

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl. 2), 19-31. https://doi.org/10.1177/00333549141291S206

Krathwohl, D. R. (2002). A revision of Bloom's taxonomy: An overview. Theory Into Practice, 41(4), 212-218. https://doi.org/10.1207/s15430421tip4104_2

Wiggins, G., & McTighe, J. (2005). Understanding by design (Expanded 2nd ed.). Association for Supervision and Curriculum Development.