Revised Project Proposal 1
Running head: LEARNING BY DESIGN - DESIGN DOCUMENT
Nursing Protocol Design
Using a Learning By Design Constructivist Learning Environment
Revised Project Proposal
Terri Ann Guingab
EDIT 732 - George Mason University
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Introduction to the Learning Problem
Evidence-Based Practice is a model for nursing practice that grounds clinical
decision making in current research, personal experience, and patient values to ensure
optimal patient outcomes. Evidence-Based Practice in nursing care has been endorsed
by a number of health-care organizations including the American Nurses Association,
the President’s Advisory Commission on Consumer Protection and Quality in the Health
Care Industry, and the Joint Commission on the Accreditation of Healthcare
Organizations (Society of Pediatric Nurses 2004).
Studies have shown a distinct lack in preparing undergraduate nursing students
to incorporate Evidence-Based Practice to its fullest extent (Cleary-Holdforth and Leufer
2008; Meeker, Jones, and Flanagan 2008; Foster 2004). Traditional undergraduate
nursing research courses have focused more on the process of conducting a nursing
study rather than fostering Evidence-Based Practice. As a result, students are less able
to synthesize research with their own personal clinical judgment and the reality of the
nursing context (Foster 2004). This may be, in part, due to the fact that as novice
nurses, they simply do not have a wide range of experience from which to base their
George Mason's School of Nursing has developed a course, NURS 417, to
respond to this need. The proposed prototype will support this course by introducing a
mechanism for reflection and exposure to multiple perspectives to the process of
developing an Evidence-Based Practice. The prototype will be grounded in the
pedagogical model of Learning by Design. Students will design a nursing protocol (a
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series of nursing actions designed to address a clinical problem) by seeking out current
research and considering the realities of clinical practice. To address the issue of lack of
experience, students will work in teams to share experiences with each other. Nurse
mentors will also be on hand to share their experiences. Students will periodically seek
out feedback on their designs from organizations related to their populations, or from
people who share characteristics of their patient populations. The students will balance
research and multiple perspectives from experts and patients in the design of their
The Target Audience
The target audience consists of full time undergraduate students in the final
semester of a traditional four year nursing program. Projected enrollment in the class is
40. Students are expected to have completed courses in nursing fundamentals, health
assessment, pathophysiology, pharmacology, and a number of clinical rotations.
Students will have also completed an introduction to nursing research (NURS 317). This
course covers seeking out research, types of study designs, and evaluating validity of a
study. Depending on their current semester clinical rotation, they will be simultaneously
enrolled in community health and management courses or in advanced pathophysiology
courses. Students will be motivated by the potential of improved patient outcomes they
will personally witness when implementing clinical decisions that have been informed by
The Knowledge Domain
Nursing by its nature is an ill-defined domain, combining art, physical science,
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social science, and technology in the delivery of nursing care. Evidence-Based Practice
incorporates nursing research and clinical experience with prior student knowledge in
the fields of biology, chemistry, nutrition, mathematics, statistics, psychology, sociology,
ethics, philosophy, management, and communication.
The general outcome of NURS 417 is for students to synthesize research,
experience, and patient preferences to develop their own protocols for nursing practice.
To that end, the following objectives are identified:
• Collaborate with team members and other classmates in the design process.
• Generate a "hypothetical protocol" based on current knowledge. Compare and
contrast current protocols with hypothetical protocol.
• Identify learning issues and allocate amongst team members.
• As an individual:
• Evaluate research for validity and relevance to the nursing protocol in
question as well as applicability to one's own nursing practice.
• Articulate relevant expertise and research findings with team members
during the protocol development phase.
• Reflect on the design process. This includes articulating individual learning
needs as well as creating and implementing plans to meet needs. This
also includes articulating and justifying (based on research and feedback)
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• Modify hypothetical protocol recommendations to incorporate peer, expert, and
patient feedback received. If necessary, conduct additional iterations of
development by identifying new learning needs, conducting further research and
receiving further feedback.
• Synthesize the results of research findings and the practical realities of the care
environment gleaned from personal experience and consultation with peers,
patients, and experts into a cohesive protocol recommendation.
• As an individual, design a nursing protocol that synthesizes nursing knowledge,
emergent research, patient feedback, and the realities of the care environment.
Students will identify an area of interest (maternity, pediatrics, gerontology, etc.)
and will be divided into small groups based on areas of interest.
Phase One - Group Work
Teams select a clinical problem in their area to which a nursing protocol would be
applied. Example protocols will be provided, or teams can suggest their own with
clearance from the faculty (to ensure the protocol is complex enough for the project).
Prior to research, students hypothesize on what their protocol might be for their
clinical problem, given their previous knowledge. They'll compare their hypothetical
protocol to existing institutional protocols. The students will discuss what issues impact
their protocol. Faculty may need to guide students in this exploration process by asking
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probing questions that lead them to consider other factors they may not have
immediately identified. Faculty will also guide students in translating identified issues
into areas the students will explore in their research.
Students divide learning issues amongst each other and each reviews the
research related to their topic. The research serves as a part of their case library of how
other nurses approached similar clinical problems. A "Case Authoring Tool", similar to
the one suggested by Kolodner and Guzdial (2000) will be provided to students to
summarize each article they find, the "strength" of the article (the scientific soundness of
the experimental design), the lessons they learned, and the applicability of the research
to the design problem and to one's own practice. The Case Authoring Tool will also
provide a separate form for students to record prior clinical experiences that may relate
to the situation at hand. These reviews will go into the class case library for anyone to
Students will also be encouraged to contact people with similar demographics to
the patient populations of their chosen area for their feedback on the protocol design
ideas. Points of contact could include patient support groups or people the students
know. It is important to emphasize that for ethical reasons, students will not test their
protocols on patients, nor will they solicit feedback from patients in their care. For
example, a student will not test a breastfeeding technique on a post-partum patient in
her care, nor will she ask hypothetically what her patient thinks of a breastfeeding
technique. However, the student is encouraged to contact a representative of La Leche
League (a breast feeding support group) or a neighbor or friend who is currently
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breastfeeding to solicit feedback on the student's design ideas.
A discussion whiteboard will allow students to discuss their findings, identify
further needs, create plans of action, and keep track of their progress. They will use a
wiki as their collaborative writing space. Each student will also maintain a personal
journal of their design experiences. They will be asked to reflect on what they've
learned, what learning issues still exist, and how they plan to address those learning
issues, as well as how what they're learning could impact future practice.
A Pin-up session will be provided at the mid-way point for teams to share their
progress with the class and receive feedback from their peers. During these pin-up
sessions, practicing nurses and nursing faculty will be invited to provide their insight on
the teams' ideas for their protocols. This would also be the time for the team to express
any challenges they are facing (such as difficulty finding research or ensuring that all
domains of knowledge involved were explored) for ideas from other teams on how to
address them. Teams will present their final protocols to the class in a gallery walk.
Students will articulate their design process and justify their protocol recommendation
with the research they've found and feedback they've received.
Phase Two - Individual Work
Students will individually design a protocol in a different area from the one they
chose during Phase One. This will be the same activity as above, only without working
in a group. Students will have access to all reflective, design management, and case
library tools from Phase One. They will still receive feedback from peers via pin-up
sessions and the gallery walk, and can still solicit feedback from patients and nurses.
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Phase One Assessment
Faculty will assess student journals for evidence of critical thinking and self
directed learning. Considerations include ability to identify learning goals and ability to
create and implement plans for meeting goals. Faculty will also analyze Case Authoring
Tool reviews for evidence of students articulating the lessons they've learned from the
research process and personal experience, and how those lessons might apply in the
future. The development of the protocol will be analyzed over time for evidence of
students applying what they've learned and feedback they've received. Students will
also be assessed on their ability to justify their design decisions based on lessons
learned from the development phase. Rubrics will be provided to evaluate performance.
Students will assess themselves on the same criteria and using the same rubric
as above. Students will assess themselves and each other on their ability to collaborate
with their team. Questions to consider include whether they followed etiquette and the
extent to which they contributed in a significant and meaningful way to the final project.
Faculty will monitor group discussion boards to assess collaboration and contribution to
the final product. Teams will evaluate each other's products for soundness of design as
well as firm justification of protocol based on the research and patient and nurse expert
Phase Two Assessment
Students will assess themselves, and faculty will assess students, on the same
criteria as above (with the exception of team work collaboration). Although teamwork will
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not be assessed, faculty will assess individual students, and students will assess
themselves, for the quality of feedback provided during pin-ups and gallery walk.
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Cleary-Holdforth, J., Leufer, T. (2008). Essential elements in developing evidence-based
practice. Nursing Standard, 23(2), 42-46.
Foster, R. (2004). Challenges in teaching evidence-based practice. Journal for
Specialists in Pediatric Nursing, 9(3), 75-76.
Kolodner, J.L. and Guzdial, M. (2000). Theory and practice of case-based learning aids.
In D.H. Jonassen & S.M. Land (Eds.), Theoretical foundations of learning
environments (pp. 215-232). Mahwah, NJ: Lawrence Erlbaum Associations.
Meeker, M.A., Jones, J.M., and Flanagan, N.A. (2008). Teaching undergraduate nursing
research from an evidence-based practice perspective. Journal of Nursing
Education, 47(8), 376-379.
Society of Pediatric Nurses (2004). Position statement on evidence based practice.
Retrieved November 12, 2008. Available at https://www.pedsnurses.org/