Preliminary Design Project Bronchitis and Emphysema 1
Preliminary Design Project Bronchitis and Emphysema
By
Lisa M. Otto
University of North Texas
CECS 6020 Advanced Instructional Design: Models and Strategies
Preliminary Design Project Bronchitis and Emphysema 2
Overview
The method of delivery for the bronchitis and emphysema lesson is a face-to-face course
using the learning management system Canvas to deploy objectives, reading assignments, lesson
materials, and student assignments. The examination method is a computerized exam executed
through the program Examsoft. The bronchitis and emphysema lesson is divided into four
modules. Module one consists of pathology, etiology, diagnostic tests, laboratory results, severity
classifications, clinical manifestations, and potential complications of bronchitis. Module two
consists of pathology, etiology, diagnostic tests, laboratory results, severity classifications,
clinical manifestations, and potential complications of emphysema. Module three consists of
applicable respiratory medications including classification, mechanism of action, drug effects,
indications, contraindications, adverse effects, indications, and dosages. Module four consists of
the application and critical thinking activities including comparing and contrasting bronchitis and
emphysema, interpreting arterial blood gases, designing a concept map, designing a medication
care plan, designing a patient care plan, and evaluating a concept map and both care plans.
Modules one, two, and three focus more on concrete learning of the disease process and
medication treatments, while module four emphasizes analysis, synthesis, and application.
Problem Situation
Today’s higher education and nursing education are experiencing a knowledge explosion
and sweeping changes (Billings, 2012). Health care reform, decreasing financial resources in
healthcare and education, integration of evidence-based practice, expanding technology, shifting
emphasis to learning instead of teaching, and a critical shortage of nursing faculty are some of
the driving forces behind these changes (Billings, 2012). Since, the Pathophysiology and
Pharmacology II course is experiencing a higher than normal fail rate and the National Council
Preliminary Design Project Bronchitis and Emphysema 3
Licensure Examination (NCLEX) pass rate for the program is declining, the focus is on
improving student learning and performance. In an endeavor to align the bronchitis and
emphysema course content with current trends in nursing education the instructional design of
the lesson includes evidence-based practice, strategies for critical thinking, and application of
knowledge, as well as the use of current technology such as computer based exams, a learning
management system, and an audience response system. The design incorporates a student
centered learning environment which expands content delivery beyond information only
encompassing demonstration, application, problem-centered strategy, peer-collaboration, and
peer-critique.
Goal
1. Demonstrate critical thinking to make patient centered care decisions when caring for a
patient with bronchitis or emphysema.
Objectives
Terminal Objectives Enabling Objectives
Upon completion of the unit, the student will be able to:
1. Design a concept map of bronchitis and emphysema (combined or separate) with pathology linked to etiology, diagnostic tests, laboratory results, severity classifications, clinical manifestations, potential complications, and respiratory medication therapy.
1.1 Define bronchitis including chronic productive cough criteria.
1.2 Define emphysema including lung changes in air spaces and walls.
1.3 Identify the clinical manifestations of bronchitis and emphysema.
1.4 Describe the pathophysiology of bronchitis and emphysema including inflammation, airflow limitations, gas exchange abnormalities, mucous production, and vascular changes.
1.5 Discuss pathology links to potential
Preliminary Design Project Bronchitis and Emphysema 4
complications of bronchitis and emphysema.
1.6 Discuss acid-base imbalance and arterial blood gas abnormalities in bronchitis and emphysema
1.7 Discuss types of patient data to use when planning care to decrease risk and predict potential complications for a patient with bronchitis and emphysema.
1.8 Identify the mechanism of action and drug effects, indications, contraindications, adverse effects, indications, and dosages of respiratory medications.
1.9 Evaluate a concept map of bronchitis and emphysema (combined or separate) using a rubric.
Upon completion of the unit, the student will be able to:
2. Plan patient care for a patient with bronchitis or emphysema including respiratory medication therapy using critical thinking and the nursing process such as assessment, planning, nursing diagnosis, implementation, and evaluation.
2.1 Compare and contrast bronchitis and emphysema definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching.
2.2 Describe the implementation of the nursing process including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to medication therapy.
2.3 Design a care plan for a patient with bronchitis or emphysema including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to the disease process.
2.4 Interpret arterial blood gases determining the respiratory system acid-base imbalance.
2.5 Evaluate a care plan for a patient with bronchitis or emphysema using a rubric.
2.6 Design a care plan for a patient with bronchitis or emphysema focusing on respiratory
Preliminary Design Project Bronchitis and Emphysema 5
medication administration and patient teaching.
2.7 Design a respiratory medication care plan including patient teaching.
2.8 Evaluate a respiratory medication care plan using a rubric.
Scope of the Unit
The foci of the lesson are bronchitis and emphysema. The instruction encompasses the
pathophysiology of airflow limitation, the related effects on the body, and treatment. The initial
content focus is bronchitis and emphysema definition, etiology, pathophysiology, clinical
manifestations, severity classifications, complications, diagnostic studies, laboratory results, and
medication treatments including inhalers and patient teaching (Lewis, 2014). The second content
focus is medication treatments with antiinflammatory agents, anticholinergics, leukotriene
modifiers, B2-adrenergic agonist (short and long acting) and combination agents including,
mechanism of action, indications, contraindications, interactions, assessment, implementation,
teaching, and evaluation as applicable (Lilley, 2014). The lesson is a part of a larger respiratory
system unit of study encompassing problems of oxygenation and ventilation inclusive of upper
respiratory problems, lower respiratory problems, and obstructive pulmonary diseases. The
lesson does not include other obstructive pulmonary diseases such as asthma, cystic fibrosis, or
bronchiectasis.
Target Learners
The target learners are nursing students pursuing a Bachelor of Science in Nursing (BSN)
in their junior year of college. The class size is one hundred nursing students. Bronchitis and
Preliminary Design Project Bronchitis and Emphysema 6
emphysema are two components of chronic obstructive pulmonary disease taught during the
second semester of nursing school in the Pathophysiology and Pharmacology II course. The
basic knowledge required for understanding the disease processes of bronchitis and emphysema
are established in multiple prerequisite subjects such as biology, chemistry, microbiology,
anatomy and physiology and several specific prerequisite courses including Health Assessment,
Pathophysiology and Pharmacology I, Human Needs I, and Professional Nursing Practice I. Prior
to enrollment in the junior II level courses, students must pass all courses in the junior one
semester with a seventy one percent or higher thus demonstrating proficiency in the following:
(1) physical assessment of each body system, (2) medication administration of all dosage forms
such as topical, inhalation, eye drops, oral, sublingual, subcutaneous, intramuscular, and,
intravenous, (3) sterile dressing changes, (4) restraint application, (5) patient transfers and
mobilization, (6) foley catheterization insertion and removal, (7) compression stocking
application and removal, (8) incentive spirometry, (9) safety assessment and measures, (10)
calculate drug dosages, (11) assess vital signs and normal parameters, (12) interpret arterial
blood gases, and (13) determine causes, clinical manifestations, compensatory mechanisms, and
treatments of respiratory acidosis and respiratory alkalosis. Regarding the respiratory system
assessment, students must demonstrate proficiency in inspection, palpation, percussion, and
auscultation, as well as, determining respiratory rate, symmetric chest expansion, tactile fremitus,
and bronchophony to progress to the junior level two courses (Jarvis, 2012).
Students enrolled in the Pathophysiology and Pharmacology II course must enroll in the
corequisite courses Human Needs II and Professional Nursing Practice II. The corequisite course
Human Needs II builds on the disease pathophysiology by teaching collaborative care and
nursing interventions. The foci are implementation of the nursing process including assessment,
Preliminary Design Project Bronchitis and Emphysema 7
diagnosis, planning, implementation, patient teaching, and evaluation. Bronchitis and
emphysema collaborative care content is made up of (1) smoking cessation, (2) oxygen therapy,
(3) complications of oxygen therapy, (4) breathing retraining, (5) airway clearance techniques,
(6) nutritional therapy, and (6) activity considerations (Lewis, 2014). The corequisite course
Professional Nursing Practice II is a clinical rotation in a hospital environment with a simulation
component. One of the simulation scenarios involves the care of a patient with emphysema or
bronchitis.
Instructional Approach
The foundation for the instructional design of the bronchitis and emphysema lesson is
Gagné’s nine instructional events. The nine instructional events delineate the necessary
conditions for learning and serve as the foundation for instructional design including the
appropriate selection of media (Gagné, 1985). The table depicts the nine instructional events,
cognitive processes and corresponding instructional activities and information.
Gagné’s events of instruction Bronchitis and emphysema unit of instruction
1. Gaining Attention (reception) 1. Tell a story about a patient with bronchitis2. Tell a story about a patient with emphysema
3. Informing learners of the objective
(expectancy)
1. Pose the questions: What is the pathophysiology of airflow
limitation and the related effects on the body What is bronchitis? What is emphysema? How does smoking affect the lungs and
other body systems? What are the effects of air pollution on the
respiratory and other body systems?2. List the objectives on the content page within the
bronchitis and emphysema lesson module of learning management system, Canvas.
Preliminary Design Project Bronchitis and Emphysema 8
3. List the objectives on the course syllabus, unit assignments, PowerPoint slide presentations, and other course materials and assignments.
4. Stimulating recall of [relevant]
prior learning (retrieval)
1. Review key structures and functions of the respiratory system including the gas exchange process.
2. Review assessment techniques of the respiratory system including normal and abnormal findings.
3. Review arterial blood gas (ABG) normal ranges and the acid-base imbalances.
5. Present the [content] stimulus
(selective perception)
1. Build on previous knowledge by presenting bronchitis and emphysema definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, and medication treatments.
2. Present medication treatments with antiinflammatory agents, anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation as applicable.
3. Present acid-base imbalance and ABG interpretation associated with bronchitis and emphysema including respiratory acidosis and respiratory alkalosis.
6. Providing learning guidance
(semantic coding)
1. Show pictures of the structural changes in the lungs due to bronchitis and emphysema.
2. Compare and contrast the pathologic and structural changes due to emphysema and bronchitis.
3. Show pictures of the patients experiencing clinical manifestations of bronchitis and emphysema.
4. Show characterizations (cartoons) representing the clinical manifestations of bronchitis and emphysema such as the blue bloater and the pink puffer.
5. Show characterizations (cartoons) representing the clinical manifestations of hypoxia.
6. Demonstrate arterial blood gas interpretation and relate finding to pathology changes, effects in gas exchange (hypoventilation), clinical manifestations, and compensation. Provide ABG interpretation handout.
7. Include text describing bronchitis and emphysema definition, etiologies, pathophysiology, clinical manifestations, severity classifications,
Preliminary Design Project Bronchitis and Emphysema 9
complications, diagnostic studies, and medication treatments, that students may read and implement Socratic questioning.
Course Assignments1. Reading assignments in the medical-surgical and
pathology textbook associated with bronchitis, emphysema, acid-base regulation, ABG interpretation, respiratory care plan, collaborative care respiratory medications. Individual student assignment.
2. Reading assignment in the pathology textbook associated with bronchitis and emphysema. Individual student assignment.
3. Reading assignments in the pharmacology textbook associated with respiratory drugs. Individual student assignment.
4. Essay questions about cigarette smoking, passive smoking, air pollution, and effects on the lungs structure and function. Small group assignment.
5. Essay questions about bronchitis and emphysema including definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results. Individual student assignment.
6. Medication study guide related to inhalers and treatments with antiinflammatory agents, anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation as applicable. Small group assignment.
7. Eliciting performance (responding) 1. Practice bronchitis and emphysema NCLEX style questions in class with an audience response system including definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.
2. Student completes comparison chart of bronchitis and emphysema depicting definition, etiology, pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching. Small group
Preliminary Design Project Bronchitis and Emphysema 10
assignment.3. Student completes bronchitis and emphysema
cased-based questions in a small group regarding disease definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching. Small group assignment.
4. Student designs a concept map of bronchitis and emphysema (combined or separate) including definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching. Small group assignment.
7. Student designs a care plan for a patient with bronchitis or emphysema focusing on respiratory medication administration and patient teaching. Individual student assignment.
8. Student designs a care plan for a patient with bronchitis or emphysema including applicable subjective and objective patient data, nursing diagnosis, interventions including patient teaching, rationale, patient outcome, and evaluation of outcome. Individual student assignment.
8. Providing feedback
(reinforcement)
1. Provide answers and rationale to practice NCLEX style questions and case-based questions.
2. Discuss NCLEX style and case-based questions and answers including rationale and clarification of content not understood.
3. Review test taking strategies such as identification of key words in the stem and tactics for eliminating incorrect answers and choosing the most correct answer.
4. Faculty provides feedback on essay questions. If answers are broad and non-specific or incorrect. Guide student to specific and comprehensive answers.
5. Faculty and peer feedback on respiratory medication study guide.
6. Faculty and peer feedback on comparison chart guiding the student to comprehensive and specific data.
7. Faculty and peer feedback on the concept map guiding the student to comprehensive and specific data.
Preliminary Design Project Bronchitis and Emphysema 11
8. Faculty and peer feedback on respiratory medication care plan. Address trends in misunderstood content relationships to the class.
9. Faculty and peer feedback on the patient care plan. Address trends in misunderstood content relationships to the class.
10. Faculty feedback on all graded assignments addressing misunderstood content relationships.
11. The learning management system canvas automatically scores the quiz. The correct answers and rationale to missed questions are available immediately after the quiz for student review. Schedule private meetings with students as needed after the quiz to provide remediation to individual students as needed
12. The Examsoft software grades the exam. The answers and rationale to missed questions are available immediately after the exam for student review. Schedule private meetings with students as needed after the exam to provide remediation to individual students as needed
9. Assessing performance (retrieval) 1. Ten question unit quiz. NCLEX style multiple choice questions at the application level including ten percent to twenty percent select all that apply question format. Student receives a grade on the quiz.
2. Seventy five question unit exam. NCLEX style multiple choice questions at the application level including ten percent to twenty percent select all that apply question format. Student receives a grade on the exam.
3. Faculty grade bronchitis and emphysema comparison chart according to rubric.
4. Faculty grade the concept map assignment according to an expert response or referenced model.
5. Faculty grade the respiratory medication care plan using a rubric.
6. Faculty grade the patient care plan using a rubric.10. Enhancing retention and transfer
(generalization)
1. Show picture representations of bronchitis and emphysema pathology and have the students identify, describe, and explain the pathology changes, the associated clinical manifestations, and corresponding diagnostic tests include Socratic questioning.
2. Students discuss in small groups the pathology and
Preliminary Design Project Bronchitis and Emphysema 12
potential complications of bronchitis and emphysema including cor pulmonale, exacerbations, acute respiratory failure, depression, and anxiety.
3. Students discuss in small groups the types of patient data to use when planning care to decrease risk and predict potential complications for a patient with bronchitis and emphysema.
4. Students complete bronchitis and emphysema case-based questions in a small group regarding disease definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.
5. Students construct a concept map in a small group of bronchitis and emphysema (combined or separate) including definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.
6. Student constructs a care plan with a focus on respiratory medication administration and patient teaching in a small group.
7. Students construct a patient care plan for a patient with bronchitis or emphysema focusing on respiratory medication administration and patient teaching.
8. Students evaluate/critique another small group’s concept map.
9. Students evaluate/critique another student’s medication care plan.
10. Students evaluate/critique another student’s patient care plan.
Preliminary Design Project Bronchitis and Emphysema 13
Justification of Instructional Approach
The curriculum builds on what the student previously learned representing a spiral design
that is consistent with the constructivist theory (Kearsley, 2016). According to the constructivist
perspective, people create internal representations or mental models in order to explain
experiences (Spector, 2016). “Internal representations constructed by a person typically build on
prior internal constructions, as knowledge and experience considered together are cumulative”
(Spector, 2016, pg. 78). The basic knowledge of the structure, function, and assessment
techniques of the respiratory system are the foundation for an expansion of knowledge to include
disease process, etiology, diagnostic tests, and clinical manifestations to identify during
assessment, as well as treatments such as respiratory system medications.
According to Kearsley (2016), the constructivist instruction principles are concerned with
enabling student readiness, arranging content in a spiral organization, and facilitating
extrapolation. One major theme in the constructivist theory is that learning is active involving the
learner selecting and transforming information and making decisions (Kearsley, 2016). The
learning activities such as designing a concept map and care plan are active process in which the
learner constructs new ideas based on current and past knowledge. The instruction promotes
going beyond the information given which is consistent with the constructivist theory and
principles.
The learning activities such as study guides, cased-based questions, essay questions,
Socratic questioning, concept mapping, care planning, and practice NCLEX style questions are
highly interconnected. The principles of cognitive flexibility theory support interconnected
knowledge sources as opposed to compartmentalized (Kearsley, 2016). According to Kearsley
Preliminary Design Project Bronchitis and Emphysema 14
(2016), “cognitive flexibility theory focuses on the nature of learning in complex and ill
structured environments.” Cognitive flexibility refers to the ability to restructure knowledge
spontaneously in response to changing situational demands” (Kearsley, 2016). Additionally,
importance is placed on opportunities for learners to construct knowledge (Kearsley, 2016).
Designing the concept map, comparison chart, and care plans facilitates the learner to develop
their own representations of information, restructure and construct knowledge, and learn.
Comparing bronchitis and emphysema in a chart format sparks the student to study
specific details that differentiate the two disease processes. The instruction materials present
specific information from multiple perspectives and use diverse examples and case studies. The
learning activities are consistent with the principles of cognitive flexibility theory, as instruction
is case-based emphasizing knowledge construction in lieu of transmission of information. Two
primary content areas of implementation of cognitive flexibility theory are medicine and biology
and it supports the use of interactive technology such as hyperlinks (Kearsley, 2016).
Today, nursing students are expected to exhibit intellectual skills such as analysis,
synthesis, and meta-cognitive skills. “One of the meta-cognitive techniques is the conceptual
map in which students draw their understanding in an explicit graphical map” (Jaafarpour,
Aazami, & Mozafari, 2016, p. 129). Concept mapping as an educational approach promotes
meaningful learning by allowing students to add new knowledge to existing knowledge in their
cognitive scaffold. In nursing education, concept mapping is used to improve learning, teaching,
and assessment of critical thinking. Since concept mapping is a visual representation of what
students think, it may be used as a method to evaluate learning (Jaafarpour et al, 2016).
Jaafarpour et al (2016) examined the learning strategy of concept mapping to enhance learning
outcomes of nursing students. Jaafarpour et al (2016) reported that “students who engaged in
Preliminary Design Project Bronchitis and Emphysema 15
map construction achieved greater marks on their cumulative tests in comparison to students who
received the traditional teaching methods and take quizzes” (p.131).
“Letting learners know what the expectations are with regard to satisfactory performance
is likely to help learners identify and accept learning goals and objectives, which is especially
critical in formal learning situations” (Spector, 2016, pp.35). Objectives indicate student
expectations regarding what they should know, be able to do, and value at the conclusion of the
lesson including evaluation and grading (Billings, 2012). Each course module in the learning
management system, Canvas, contains a content page with lesson objectives and corresponding
hyperlinks to learning activities. Placing learning activities in close proximity to associated
objectives enables the students to view the learning activities, course objectives, and content
from an interrelated and holistic point of view (Billings, 2012).
Blooms taxonomy is a framework for classifying expectations or intentions of what
students should learn as a result of education. Most frequently, Blooms taxonomy is used to
classify curricular objectives and test items to demonstrate the breadth across the categories
(Krathwolh, 2002). The revised Bloom’s Taxonomy depicts six levels of cognitive processes
remember, understand, apply, analyze, evaluate, and create. The six major categories are
generally a hierarchical representation of increasing complexity with remember being least
complex and create being most complex. However, the objectives involving understanding and
use of knowledge are considered the most important goals in education and classified from
understand to create (Krathwohl, 2002). Placement of the objectives in a table format
representing the six cognitive process dimensions provides an indication of the extent of
complex knowledge and cognitive processes involved (Krathwohl, 2002). The table exhibits the
educational objectives for the bronchitis and emphysema lesson.
Preliminary Design Project Bronchitis and Emphysema 16
Remember Understand Apply Analyze Evaluate Create
Objective 1
Objective 2
Objective 3
Objective 4
Objective 5
Objective 6
Objective 7
Objective 8
Objective13
Objective14
Objective 12 Objective 9 Objective 16
Objective 17
Objective 10
Objective 11
Objective 15
The operant condition theory is a behavioral learning theory accredited to B.F. Skinner
(1954). The basis of this theory is that learning is a function of change in overt behavior.
Reinforcement is the key process involved in such change and designed to encourage desired
consequences (Spector, 2016). “Reinforcers are anything that strengthens the desired response”
(Kearsley, 2016). Some examples of reinforcers are written praise, verbal praise, good grades, or
a feeling of accomplishment (Kearsley, 2016) Operant conditioning’s principles also support
timely and informative feedback to learners (Spector, 2016). The concept of faculty and peer
feedback as well as immediate feedback is threaded throughout the instructional design of the
bronchitis and emphysema lesson.
Formative and Summative Assessment
Preliminary Design Project Bronchitis and Emphysema 17
“A performance of some kind represents an outcomes aspect of learning” (Spector, 2016,
pp.35). Various learning activities and practice activities may involve a performance. Generally,
a learner’s observable response due to a test-item, problem-solving activity, or other learning
situation is performance. Performances are observable, measureable, and linked to learning
outcomes (Spector, 2016). The bronchitis and emphysema lesson incorporates performance
measures including essay questions, comparison chart, study guide, care plan, concept map, quiz,
and exam.
“Formative assessment and learner feedback are critical factors in promoting effective
learning processes (Spector, 2016, pp.32). A goal of formative evaluation is to improve learning
and competence throughout the process of instruction by continual assessment of student
learning, specific student performance feedback, and improving teaching strategies (Baumlen,
2015). Summative evaluation essentially sums up or summarizes the overall achievement of the
student at the end of the instruction, course, or lesson. Overall, the summative evaluation
determines the achievement of the student and outcome of the education. Some examples of
summative evaluation methods include exams, written assignments, cap stone projects, and
course grade (Baumlen, 2015).
According to Spector (2016), “An instructor does not know what learning has occurred
without having some measures or indicators or change in performance or ability” (pg. 36). The
instructional design of the bronchitis and emphysema lesson provides for both formative and
summative assessments including faculty and peer feedback. The essay questions, study guide,
quiz, and comparison chart assignments involve formative feedback. The care plan, concept map,
and seventy five question exam provides summative evaluations of student achievement and
outcome of the education.
Preliminary Design Project Bronchitis and Emphysema 18
Grading rubrics typically guide the student regarding the expectation level for an
assignment, while the teacher uses the rubric to grade the assignment (Baumlen, 2015). “The
most essential characteristic of a robust and meaningful rubric is that the data are measureable
and directly connected to the student learning outcomes the assignment is designated to
measure” (Baumlen, 2015, pp.56). The instructional design is set up such that the essay
questions, study guide, and comparison chart are graded according to a corresponding rubric.
According to Spector (2016), “one can ask a learner to create a representation of the problem
space associated with a particular problem scenario and then compare that response with an
expert response or reference model” (pp.32). The instructional design of the lesson supports the
use of an expert response or reference model to grade the concept map and care plan.
“Learning should be assessed and feedback given to students in a timely manner, enabling
them to see their progress and make decisions about their learning” (Billings, 2012, pg. 85). The
instructional design allows for a learning management system and Examsoft program to grade
quizzes and exams immediately upon completion. The correct answers and rationale to missed
questions are available directly after the quiz for student review.
Tests assess the students’ understanding of content and the ability to think at each level
including remember, understand, apply, analyze, evaluate, and create (Baumlen, 2015). Some
examples of test item formats are multiple choice, true or false, matching, short answer, fill in the
blank, ordered response, and multiple choice with multiple response. The most appropriate item
format selection is based on which format directly measures the intended learning outcome
(Baumlen, 2015). The instructional design supports ninety percent of the test items equating with
understand, apply, analyze, evaluate, and create categories. The bronchitis and emphysema
lesson plan include seventeen objectives in total. Specifically, there are two objectives in the
Preliminary Design Project Bronchitis and Emphysema 19
remember category and fifteen objectives that correlate to the understand through create levels.
According to Mayer (2002), “When the goal of instruction is to promote transfer, objectives
should include the cognitive processes associated with understand, apply, analyze, evaluate, and
create (pp.232).
Evaluation Plan
The term evaluation is used to refer to programs and projects as in ‘evaluating courses’
(Spector, 2016, p.32). Evaluation methods may include student feedback through discussion or
course evaluation, peer review of teaching strategies through classroom observation and
assessment of course materials, and faculty course reports including types of instructional
methods, rationale, and changes to these methods (Billings, 2012). Course faculty, administrative
personnel, and faculty peers may review course evaluations and course reports annually in an
effort to evaluate teaching strategies. Nursing program outcome measures consist of entry and
graduation rates, certificate of graduates, first time pass rate on the National Council Licensure
Examination for Registered Nurses (NCLEX-RN), licensure, postgraduation employment rates,
and employer surveys (Billings, 2012). The implementation of the bronchitis and emphysema
lesson instructional design is evaluated through course evaluations, student feedback, faculty
peer review, faculty course reports, and overall program outcome measures in addition to student
performance on assignments, exams, and final course grade.
Preliminary Design Project Bronchitis and Emphysema 20
References
Baumlein, G. (2015). Use assessment and evaluation strategies. In Caputi, L (Eds.), Certified
Nurse Educator Review Book: The Official NLN Guide to the CNE Exam. Philadelphia,
PA: Wolter Kluwer.
Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty. St. Louis,
MO: Elsevier/Saunders.
Gagne, R. (1985). The conditions of learning (4th ed.). New York: Holt, Rinehart & Winston .
Gagné, R., Briggs, L. & Wager, W. (1992). Principles of instructional design (4th Ed.). Fort
Worth, TX: HBJ College Publishers.
Gagné, R. M., & Merrill, M. D. (1990). Integrative goals for instructional design. ETR&D
Educational Technology Research and Development, 38(1), 23-30.
Huether, S.E., McCance, K.L., Brashers, V.L. & Rote, N.S. (2013). Understanding
pathophysiology (5th ed.). St. Louis: Mosby- Elsevier.
Jaafarpour, M., Aazami, S., Mozafari, M. (2016). Does concept mapping enhance learning
outcome of nursing students? Nurse Education Today, 36, 129-132.
Jarvis, C. (2012). Physical examination and health assessment (6th ed.). Philadelphia: W. B.
Saunders.
Kearsley, G. (2016). The Theory Into Practice Database. Retrieved from
http://InstructionalDesign.org
Krathwohl, D. R. (2002). A revision of bloom's taxonomy: An overview. Theory into
Practice, 41(4), 212-218.
Lewis, S.L., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical nursing:
Assessment and management of clinical problems (9th ed.). St. Louis: Mosby.
Lilley, L.L., Collins, S. R., & Snyder, J. (2014). Pharmacology and the nursing process (7th
Preliminary Design Project Bronchitis and Emphysema 21
ed.). St. Louis, MO: Mosby-Elsevier.
Mayer, R. E. (2002). Rote versus meaningful learning. Theory into Practice, 41(4), 226-232.
Richey, R. C. (Ed.) (2000). The legacy of Robert M. Gagné. Syracuse, NY: The ERIC
Clearhinghouse on Information and Technology. Retrieved from
http://eric.ed.gov/?id=ED445674
Spector, J. M. (2016). Foundations of educational technology: Integrative and interdisciplinary
perspectives (2nd ed.). New York: Routledge.
Zerwekh, J., Claborn, J.C., & Miller, C.J. (2007). Memory notebook of nursing: Volume 1
(3rd ed.). Texas: Gingerbread Press.
Preliminary Design Project Bronchitis and Emphysema 22
Appendix A
Learning Management System Home Page Bronchitis and Emphysema Lesson
Module 2Emphysema
Disease Process
Module 3Respiratory Medications
Module 4Critical Thinking
Exercises
Module 1Bronchitis
Disease Process
Bronchitis and Emphysema Lesson
Preliminary Design Project Bronchitis and Emphysema 23
Appendix B
Learning Management System Module 1 Bronchitis Content Page
Module 1 Pathology, clinical manifestations, and potential complications of bronchitisObjectives 1. Define bronchitis including chronic productive cough criteria.
2. Identify the clinical manifestations of bronchitis.3. Describe the pathophysiology of bronchitis including inflammation, airflow
limitations, gas exchange abnormalities, mucous production, and vascular changes.
4. Discuss pathology links to potential complications of bronchitis.5. Discuss types of patient data to use when planning care to decrease risk and
predict potential complications for a patient with bronchitis.6. Discuss acid-base imbalance and arterial blood gas abnormalities in bronchitis.
Reading Assignment
1. Medical-Surgical textbook pages
2. Pathology textbook pages
3. Medical-Surgical textbook acid base balance and ABG interpretation pagesLesson Materials
1. PowerPoint Lecture Bronchitis (hyperlink)2. ABG Interpretation Handout (hyperlink)
Student Assignment
1. Essay Questions (hyperlink) Topics: Cigarette smoking, passive smoking, air pollution, and effects
on the lungs structure and function, completed in a small group.2. Essay Questions (hyperlink)
Topics: Bronchitis etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching
3. Practice NCLEX Style Questions (hyperlink) In class with audience response system Topic: Bronchitis
Preliminary Design Project Bronchitis and Emphysema 24
Appendix C
Learning Management System Module 2 Emphysema Content Page
Module 2 Pathology, clinical manifestations, and potential complications of emphysemaObjectives 1. Define emphysema including lung changes in air spaces and walls.
2. Identify the clinical manifestations of emphysema.
3. Describe the pathophysiology of emphysema including inflammation, airflow limitations, gas exchange abnormalities, mucous production, and vascular changes.
4. Discuss pathology links to potential complications of emphysema.
5. Discuss types of patient data to use when planning care to decrease risk and predict potential complications for a patient with emphysema.
6. Discuss acid-base imbalance and arterial blood gas abnormalities in emphysema.
Reading Assignment
1. Medical-Surgical textbook pages2. Pathology textbook pages3. Medical-Surgical textbook acid base balance and ABG interpretation pages
Lesson Materials
1. PowerPoint Lecture Emphysema (hyperlink)2. ABG Interpretation Handout
Student Assignment
1. Essay Questions (hyperlink) Topics: Emphysema etiologies, pathophysiology, clinical
manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching
2. Practice NCLEX Style Questions (hyperlink) In class with audience response system Topic: Emphysema
Preliminary Design Project Bronchitis and Emphysema 25
Appendix D
Learning Management System Module 3 Respiratory Medication Content Page
Module 3 Respiratory medications including classification, mechanism of action and drug effects, indications, contraindications, adverse effects, indications, and dosages.
Objectives 1. Identify the mechanism of action and drug effects, indications, contraindications, adverse effects, indications, and dosages of respiratory medications.
Reading Assignment
1. Pharmacology textbook pages2. Davis Drug Guide textbook pages3. Medical-Surgical textbook collaborative care respiratory medications pages
Lesson Materials
1. PowerPoint Lecture Respiratory Medication (hyperlink)
Student Assignment
1. Student Medication Study Guide (hyperlink) Small group work Topic: Inhalers and treatments with antiinflammatory agents,
anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation
2. Practice NCLEX Style (hyperlink) In class with audience response system Topic: Respiratory medications
Preliminary Design Project Bronchitis and Emphysema 26
Appendix E
Learning Management System Module 4 Critical Thinking Content Page
Module 4 Critical Thinking ActivitiesObjectives 1. Compare and contrast bronchitis and emphysema definition, etiology,
pathophysiology, clinical manifestations, complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching.
2. Describe the implementation of the nursing process including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to medication therapy.
3. Design a care plan for a patient with bronchitis or emphysema including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to the disease process.
4. Evaluate a care plan for a patient with bronchitis or emphysema including nursing diagnosis, planning, implementation, evaluation, and patient teaching in relation to the disease process using a rubric.
5. Design a respiratory medication care plan including patient teaching.
6. Evaluate a respiratory medication care plan using a rubric.
7. Interpret arterial blood gases determining the respiratory system acid-base imbalance.
Reading Assignment
1. Medical-Surgical textbook care plan respiratory care pages2. Care Plan textbook ineffective airway clearance and impaired oxygenation
pages3. Medical-Surgical textbook acid base balance and ABG interpretation pages
Lesson Materials
1. Comparison Chart Directions (hyperlink)2. Care Plan Directions (hyperlink)3. Example Care Plan (hyperlink)4. Concept Map Directions (hyperlink)5. Example Concept Map (hyperlink)6. Example ABG Interpretation Handout (hyperlink)
Student Assignment
4. Comparison Chart (hyperlink) Small group work Topic: Definition, etiology, pathophysiology, clinical manifestations,
complications, diagnostic studies, laboratory results, and medication treatments including inhalers and patient teaching
5. Medication Care Plan (hyperlink) Topic: Respiratory medication administration and patient teaching.
6. Patient Care Plan (hyperlink) Topic: Applicable subjective and objective patient data, nursing
Preliminary Design Project Bronchitis and Emphysema 27
diagnosis, interventions including patient teaching, rationale, patient outcome, evaluation of outcome.
7. Concept Map (hyperlink) Small group work Topics: Definition, etiologies, pathophysiology, clinical manifestations,
severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching
1. Case-Based Questions (hyperlink) Small group work Topic: Bronchitis disease definition, etiologies, pathophysiology,
clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.
Topic: Emphysema disease definition, etiologies, pathophysiology, clinical manifestations, severity classifications, complications, diagnostic studies, arterial blood gases, and medication treatments including inhalers and patient teaching.
Topic: Inhalers and treatments with antiinflammatory agents, anticholinergics, leukotriene modifiers, B2-adrenergic agonist (short and long acting) and combination agents including, mechanism of action, indications, contraindications, interactions, assessment, implementation, teaching, and evaluation
Preliminary Design Project Bronchitis and Emphysema 28
Appendix F
Bronchitis Cartoon Character Representation
(Zerwekh, Claborn, & Miller, 2007)
Preliminary Design Project Bronchitis and Emphysema 29
Appendix G
Emphysema Cartoon Character Representation
(Zerwekh et al., 2007)
Preliminary Design Project Bronchitis and Emphysema 30
Appendix H
Chronic Obstructive Pulmonary Disease Cartoon Character Representation
(Zerwekh et al., 2007)
Preliminary Design Project Bronchitis and Emphysema 31
Appendix I
Hypoxia Cartoon Character Representation
(Zerwekh et al., 2007)
Top Related