Course Portfolio

Introduction

The course I have chosen for this Portfolio is NURS 223 Maternal Child Health Nursing. This portfolio will allow others to view and critique my teaching methods. It will also serve as a means to demonstrate my scholarly and effective teaching methods.

Course Description

NURS 223 Maternal Child Health Nursing is offered in the second year of a two year associate degree program in nursing at Name Withheld Community College, located in north eastern Pennsylvania. It is the third clinical nursing course offered in a sequence of seven. This course provides an emphasis on providing nursing care to the childbearing family through the nursing process; exploration of the role of the registered nurse related to pregnancy, childbirth, and newborns in acute care and community settings.

Prerequisites are BIOS 204 Anatomy and Physiology I, BIOS 254 Anatomy and Physiology II, PSYC 103 Introduction of Psychology, NURS 101 Introduction to Nursing, NURS 210 Nursing Care of Patients with M/S Problems I, NURS 211 Nursing Care of Patients with M/S Problems II. Corequisites are BIO 202 Microbiology, SOCA Sociology elective, NURS 224 Mental Health Nursing. (Name Withheld Community College, 2006)

Course Objectives

Upon completion of this course, the student will be able to:
· Demonstrate critical thinking utilizing the nursing process to plan and provide care for the childbearing and childrearing families.
· Apply knowledge of nursing principles to provide safe and effective nursing care to maternity and pediatric patients.
· Utilize principles of communication to establish a caring, therapeutic relationship with patients and families.
· Communicate effectively with supervisors, peers, coworkers, and members of the health care team.
· Utilize legal-ethical principals in providing care for childbearing families and childrearing families.
· Provide preventative and restorative health education to patients and their families for common health problems.
(Name Withheld Community College, 2005)

Teaching Philosophy

I believe that becoming a nurse is more than just learning nursing tasks and theories. It is a way of thinking and a way of life. One of the key elements of a nurse is the skill of critical and analytical thinking. In keeping with the philosophy of the Allied Health and Science Division of Name Withheld Community College (2006) to taking a student-centered approach to teaching, I choose to teach this course using a holistic constructivist approach. I believe this is the best way for nurses to be taught and developed.

Constructivists believe that teachers cannot give students knowledge, but facilitate learning. A learner’s knowledge is constructed or built upon their existing knowledge. Learning is a collaborative effort between student and teacher. They follow the belief that each learner is an individual, is responsible for their own learning, learns through social interaction, and is motivated by positive learning experiences. (Young, L. E. & Paterson, B. L., 2007)

My goal is for my students to gain empowerment through their education, and a desire to continue educating themselves once they leave the classroom. I believe this is accomplished through self directed learning and self accomplishment. My teaching and course design is based on the four principles of holistic constructivist approach to education:

1. Student work must be individualized and actively involve students in projects that they develop to be meaningful to their professional work and development, based on their experiences and background knowledge.
2. Student work should address problems encountered in the student’s classroom, school, and community and should have an audience beyond the teacher and beyond the university.
3. Student work should develop through collaboration and problem solving with faculty and peers.
4. Evaluation procedures should be based on authentic assessment of student work, involve self-reflection, and provide an opportunity to learn from mistakes.
(Bacon, E.H. & Bloom, L.A., 1992)

These four principles are addressed in my course through active, engaging lectures and discussions, case studies, role-playing, group work, ethical exploration paper, presentations, journaling, and evaluations.

Using the holistic constructivist theory, my goal is also to be a mentor to my students. Mentoring is dynamic and is very different than preceptorship. Mentors assist mentees in discovering and developing their own strengths. Many who have experienced a mentoring relationship find that the “mentor’s influence transcends space and time and helps to guide a ‘mentee’ long after the mentor and mentee no longer work with each other.” (Thomka, 2006, p. 54) Instead of imparting information to the class, my role is to mentor and coach the students, listen to their interactions, and provide meaningful feedback. If they become “off track,” my role is to help them get “back on track.” Each day of class I will engage my students in active thinking and provide opportunities for them to practice thinking and reasoning, and to also develop these skills. This will be accomplished through different teaching methods such as engaged lecture, case studies, group activities and discussions, role-playing and self reflection.

I believe in taking a nurturing approach with students, and providing a safe environment for learners. I provide an environment of caring, trust and support where students are encouraged for their efforts, not just their achievements. They are encouraged to “think out loud” and think spontaneously. Their efforts are supported both by their peers and I, and students learn that their achievements come from their own abilities and efforts, not from my teaching skills. (Pratt, D. & Collins, J., 2001)

I also believe in stimulating students regarding social values and ideas. Students are encouraged to challenge the status quo and take social action to improve their lives and that of others. As I believe that nursing will become part of all aspects of their lives, issues such as horizontal hostility and the image of nurses in the media are areas that my students will be made aware of and left to contemplate. My goal is that they will develop into not only patient advocates, but nurse advocates as well.

As a nurse educator and a mentor, I am well respected by my peers and members of my healthcare team for my knowledge and my nursing skills, and I consider myself an expert in Maternal/Newborn nursing. I believe it is essential to demonstrate positive leadership and mentorship to students and in my life. I am devoted to the field of nursing and the education of nurses.

Course Design and Teaching Approach

NURS 223 has an average class size of 40 students. The course takes place the first eight weeks of the semester, and is followed by NURS 224 Mental Health Nursing for the remainder of the semester. The class meets twice per week on campus for the didactic portion of the course. They also meet once per week off campus for the clinical laboratory portion of the course. Clinical laboratory takes place in various local hospitals for 10 hours per week, a total of 80 hours for this course. Classroom learning takes place a total of 5 hours and 40 minutes per week. During the semester, the class will meet for a total of 24 times, including Clinical Laboratory. The content of the course in broken down into four units and each unit has its own designated objectives. By providing specific learning objectives for each unit, students are able to better understand what is expected from the learner and are then able to focus their learning based on these objectives. Content covered appears in Table 1:

Table 1:

1. Unit 1 - Introduction to NURS 223, Family Planning, Infertility
2. History of Midwifery, Prenatal Nutrition, S/S of Pregnancy
3. Clinical Laboratory
4. Fetal Development
5. Ante-Partum Complications
6. Clinical Laboratory
7. Exam 1
8. Unit II - The Laboring Patient
9. Clinical Laboratory
10. Maternal Fetal Monitoring, Maternal And Fetal Assessment In Labor
11. Maternal Complications In Labor
12. Clinical Laboratory
13. Unit III - Post-Partum, Infant Nutrition
14. Post-Partum Complications
15. Clinical Laboratory
16. Exam 2
17. Unit IV - The Newborn
18. Clinical Laboratory
19. High Risk Newborn
20. Ethical Paper Presentations
21. Clinical Laboratory
22. Ethical Paper Presentations
23. Final Exam
24. Clinical Laboratory

Students are required to purchase the NURS 223 Maternal Child Health Study Guide. This study guide provides students with the course and unit objectives, required readings, case studies, and role-playing activities. Students are expected to be prepared for each class by performing the required readings. Students are required to take three exams during this course consisting of 50 questions each. These exams are modeled after the NCLEX examination. This consists of 75% of the student’s course grade, 25% allotted for each exam. The ethical paper and presentation are allotted 20% of the course grade and the case studies and role playing activities are allotted the other 5%.

Using the strategy of Text Interaction (DeYoung, S., 2003), each student is encouraged to write down a question or questions regarding the information covered. Areas such as the material being unclear, conflicting information, and differences from their clinical experiences are addressed. Students read their questions aloud and explain the information they are seeking. Fellow students will help provide the answers as I help to facilitate this interaction. An example of Text Interaction is as follows:

Student: “What are some of the more common complications of receiving an epidural? When I was in clinical I heard the physician tell the patient that it is safe and complications were so rare. He asked her if she wanted him to explain the complications. The patient was in labor and could care less, she just want to be relieved of the pain. Our text book states several complications relating to an epidural, but which ones, if any, are most often seen?”

Fellow students would be encouraged to explore the answers. I would direct the discussion by asking such questions as:

“Knowing what you know about epidurals, which do you think are the most common?”

“In your clinical experiences, what have you seen the nurses do prior to, during, and after a patient receives an epidural?”

“What is the rational behind these actions?”

“What is the difference between spinal anesthesia and epidural anesthesia?”

“When would be the better time to explain the risks to the patient?”

“Instead stating that an epidural is ‘safe,’ what other ways could the physician explained it to the patient that would enable the patient to make a more informed decision?”

This interaction not only helps to facilitate social learning and critical thinking, it also provides me the opportunity to explore the student’s explanations and rationales, and their interactions with each other. It also allows me to gauge if the students are “on track.” I will use this time to determine if an individual student is in need of more individualized coaching.

Class will consist of an engaged lecture where students will provide explanations for the material to be covered, and be encouraged to ask questions and stimulate open discussions. A case study and role-playing activity will occur for each unit and will focus on the information in the required readings. The case studies activities will take place in assigned groups of six students and are presented in class on designated days. Students will work together as a group outside of class and then present the case study and their findings to the class. Discussion regarding the groups findings and other possible scenarios will be discussed. For the role playing exercise, students are selected randomly that day and perform the exercise for the class spontaneously. The class then discusses what occurred and alternative ways to approach the situation. This teaching approach provides social interaction learning opportunities, and also provides students with a more realistic application of their learning.

Students are required to write a paper based on an ethical situation that they have witnessed or experienced regarding Maternal Child Health. The student is also required to present the information to the class in a 10 minute presentation. A 10 minute discussion will then ensue after each presentation. The time allotted is strictly enforced to ensure all students are granted the same opportunity for their presentation. The requirements for the ethical paper are:

1. Determine a situation that deals with the area of maternity and newborns that you have personally observed or experience.
2. Develop an ethical question based on this observation or experience. Present both sides of the issue and its reasoning.
3. Provide supporting data for each side.
4. Present your personal views.
5. Determine the nurse’s role regarding this ethical question.
6. Identify a societal value or view regarding this issue that you believe is unjust. As a nurse, what can you do to change this or bring about awareness?

The ethical paper provides the opportunity for the student to self reflect on their own views and values and how these affect their patients. It will help them to realize their ethical and moral responsibility as nurses and to respect their patient’s views and values.

Clinical Laboratory provides nursing students with the opportunity to observe and participate in nursing practice in an authentic environment and context. This is an essential part of nursing education. In Clinical laboratory, students are able to integrate theoretical teachings with real situations. Clinical laboratory is conducted using a cognitive apprenticeship approach, a type of constructivist teaching, as described by Brown, J.S., Collins, A. & Duguid, P. (1988) and cited by Cope, P., Cuthbertson, P. & Stoddart, B. (2000). Instruction is provided to the students to develop their competence through modeling, coaching, scaffolding, fading, articulation, reflection, and exploration. Students are also required to maintain a clinical journal for each clinical day. This journal will promote self reflection, critical thinking, and self confidence. Each journal entry will address the following four questions:

1. What did you learn today?
2. Describe how your experience was different or the same as to what you have learned in class or in the readings?
3. What did you do well today?
4. What would you do differently next time?

Measurement of Outcomes

Classroom assessment and evaluation of learning will be assessed through: 1) Informal anonymous questions 2) Likert scale evaluations 3) Pre and post-test 4) Text Interaction 5) Group assignments 6) Multiple choice exams 7) Ethical paper 8) Criterion-Referenced Clinical Evaluations 9) Informal ongoing clinical evaluation.

Informal questions will be asked once per week at the last five minutes of class. Students will be asked to anonymously answer the following questions:

1. What aspect of the class do find most helpful for your learning?
2. What aspect of the class do you find the least helpful?

These questions will allow me to determine if my teaching approach is working and areas that I may need to expand or change.

A Likert scale type questionnaire will be given to students at the end of each unit to determine if my teaching approach is allowing students to meet my goals and learning objectives through the student’s perspective. An example of this questionnaire appears in Table 2:


Table 2
Class and Teaching Evaluation NURS 223 MCH Nursing

To provide you with the best learning experience, please answer the following questions. Your evaluations are will be kept anonymous and will help me to improve this class. Thank you.

Rating Scale: 1 = Disagree 2 = Somewhat Agree 3 = No Opinion 4 = Agree 5 = Strongly Agree

1. Do you feel that the Unit Objectives have been met?

1.) О 2.) О 3.) О 4.) О 5.) О

2. Do you feel that the Case Studies helped you to meet these
objectives and facilitated your learning?

1.) О 2.) О 3.) О 4.) О 5.) О

3. Do you feel that the Role Playing helped you to meet these
objectives and facilitated your learning?

1.) О 2.) О 3.) О 4.) О 5.) О

4. Do you feel the required readings helped you to meet these
objectives and facilitated your learning?

1.) О 2.) О 3.) О 4.) О 5.) О

5. Do you feel the lectures helped you to meet these objectives
and facilitated your learning?

1.) О 2.) О 3.) О 4.) О 5.) О

6. Do you feel the class discussions helped you to meet these
objectives and facilitated your learning?

1.) О 2.) О 3.) О 4.) О 5.) О

7. Do you feel the instructor is well prepared?

1.) О 2.) О 3.) О 4.) О 5.) О

8. Is the instructor willing and available for help?

1.) О 2.) О 3.) О 4.) О 5.) О

9. Does the course demand you to think and arouse your interest?

1.) О 2.) О 3.) О 4.) О 5.) О

Please comment on the following:

10. Are the instructor’s methods appropriate to the size and type of class? If not, in what ways could they be more effective?
_________________________________________________________________________
_________________________________________________________________________
11. Comment of the quantity and quality of the exam(s):
_________________________________________________________________________

_________________________________________________________________________
12. Comment on likes and dislikes of the course:
_________________________________________________________________________

_________________________________________________________________________
13. Do you have any suggestions for changes or improvements of the course?
_________________________________________________________________________

_________________________________________________________________________



A short test consisting of 20 questions is given on the first day of class, and the same test is given on the last day of class. The test questions are multiple choice and pertain to the main learning objectives of the course and/or each unit. This will allow me to evaluate how knowledgeable the students were regarding maternal child nursing before participated in NURS 223, and how much they learned from the class. Using Text Interaction, as described in the Course Design and Teaching Approach of this portfolio, I can to evaluate how well students are assimilating their new knowledge and if my teaching techniques are accomplishing my goals and the course objectives. Group assignments will allow me to determine if the students are learning and also how well they work with others. Multiple choice exams give students the opportunity to experience a NCLEX type exam and to evaluate their knowledge of the material and their ability to pass the NCLEX. The ethical paper allows me to evaluate the student’s ability for self reflection and their ability to learn through this reflection.

Clinical laboratory will be evaluated through Criterion-Referenced Clinical Evaluations (DeYoung, S., 2003) that will be formal given mid-term and end of term. This method of evaluation incorporates a pass/fail grade and provides specific criteria that they students must accomplish in order to pass the clinical portion of the class. A copy of this evaluation is given to each student on the first day of clinical laboratory. The evaluation is reviewed with students by the instructor to ensure the criterion is clear to the students. Students will also receive ongoing informal evaluations that will occur as an interaction between student and teacher. Students will be made aware of areas that need improvement and areas they are excelling in. The criteria is broken down into the following areas: 1) Assessment 2) Nursing Diagnosis 3) Planning 4) Implementation 5) Evaluation 6) Communication 7) Professionalism 8) Accountability 9) Participation and 10) Progression. An example of an evaluation of one criterion is provided in Table 3.

Table 3
Criteria:
Communicates therapeutically with patients (Select one):

- Communicates only when absolutely necessary.
Information provided is sometimes accurate. Does
not engage in active listening.

Points = 1

- Communicates on a social level. Information given
is accurate. Actively listens to patient concerns.

Points = 2

- Actively listens and responds to patient concerns in
a professionally helpful and accurate way.

Points = 3
(DeYoung, S., 2003, p. 251)


Reflection

I was first asked to teach this class in the fall semester of 2005. I was given the daunting task to be the lead instructor one week before the class began. I had no previous experience teaching in a college or university setting and had no formal schooling regarding teaching. What I did have was the strong desire to teach and I felt extremely honored to be asked to take on this tremendous challenge. The only tools I was given was the text book, the course objectives, and the class schedule.

Since I had little time and guidance, I began to create the lectures for the class, summarizing the key points of the required readings. This is how I was taught in nursing school, and I found it comfortable to mimic this behavior. After my first week of teaching, I realized I have chosen the right vocation. After teaching my second and third week, I began to notice student’s eyes drifting, and the appearance of boredom. I realized that I was “spoon feeding” them, summarizing the chapters for them, but not truly teaching them. I began to change my style, and incorporate personal stories in my lecture. I began to ask students questions regarding what they were experiencing during their clinical laboratory. I include visual aides that were not included in their required readings. I also began to engage students in my lectures, having them “filling in the blanks.” What I soon discovered was the student’s appeared to enjoy class now. I also discovered that I enjoyed class and felt a greater enthusiasm than I did earlier.

An evaluation at the end of the course was given. The college created questionnaire consisted of 14 questions that were answered based on a Likert scale, and then nine questions were students had to write comments. Interestingly, most students did not answer the first 14 questions, but answered most of the nine questions. Some student comments were:

“I liked how the teacher brought personal stories to reinforce concepts.”

“Always willing to answer questions.”

“Susan was very knowledgeable on subject and offered interesting personal examples.”

“This teacher is extremely prepared and includes all class in discussion.”

“This professor is professional, organized, thorough and knowledgeable. This semester
has been an exceptional learning experience.”

“The teaching methods were good. Videos, slides and pictures help with learning.”

“Susan facilitated an excellent learning environment.”

“The teacher is very helpful and seeks out the students that may need help.”

These comments inspire me and also reinforce that my student centered teaching style allows me to accomplish my goals. By the end of the class, eight weeks later, I found that I was the one who learned tremendously that semester. I discovered that lecture I was originally giving was fruitless and non-fulfilling, compared to engaging students, helping them to think and discover on their own, and sharing discussions and stories. Although I knew nothing about constructivism, I now realize that I had incorporated this style of teaching in this class and it naturally fit. This is why I am a true believer in this theory of teaching.


References

Bacon, E.H. & Bloom, L.A., (1992). Beyond the herring sandwich phenomenon: A holistic constructivist approach to teach education. Journal of Learning Disabilities, 28(10), 636-645.

Cope, P., Cuthbertson, P. & Stoddart, B. (2000). Situated learning in the practice placement. Journal of Advanced Nursing, 31(4), 850-856.

DeYoung, S. (2003). Teaching strategies for nurse educators. Upper Saddle River, NJ: Prentice Hall.

Name Withheld Community College, 2006. Course Descriptions. Retrieved on November 14, 2006 from http:// www. NameWithheld.edu/Academics/Course_descriptions/ nursing.htm.

Name Withheld Community College, 2006. Nursing Department Philosophy. Retrieved on November 14, 2006 from http:// www. Name Withheld.edu/academics/divisions/alliedhealth.

Name Withheld Community College, 2005. Nursing Department NURS 223 Maternal Child Health Nursing Fall 2006 & Spring 2007 Cluster. Name Withheld, PA: Author.

Pratt, D. & Collins, J. (2001). Teaching Perspective Inventory. Retrieved on September 24, 2006, from http:// www. teachingperspectives.com.

Thomka, L. (2006, February). Are we there yet? The long and winding journey of mentoring. MODRN Nurse Magazine, 2(1), 49-55).

Young, L.E. & Paterson, B.L. (2007). Teaching Nursing: Developing a Student-Centered Learning Environment. Philadelphia: Lippincott Williams & Wilkins.