NURS 8544 Week 10 Teaching Innovation Proposal Example

Predict, Then See: A Teaching Innovation Proposal to Replace a Recorded Fluid and Electrolyte Lecture With a Structured Prediction Exercise

Student Name

College of Nursing, Walden University

NURS 8544: Strategies for Teaching Innovations in Nursing Education

Instructor Name

Month Day, Year

Predict, Then See: A Teaching Innovation Proposal to Replace a Recorded Fluid and Electrolyte Lecture With a Structured Prediction Exercise

The Learning Problem

In the adult health course taken in the second year at a composite two-year nursing college, fluid and electrolyte balance is taught through a 50-minute recorded lecture that learners watch before class. Exam results show that learners can define hyponatremia, hypokalemia and fluid volume excess, but fewer than half can predict what will happen to a patient's sodium level or urine output after a common intervention, such as several liters of hypotonic fluid after surgery or a loop diuretic in heart failure. Learners know the categories but cannot reason forward from a cause to its effects. Recorded lectures deliver the categories efficiently. They do not ask learners to make a prediction and find out whether it was right.

The Proposed Strategy

The proposal replaces the recorded lecture with a structured prediction exercise delivered in the first 50 minutes of the class session. Learners receive a short reference sheet, two pages, covering the distribution of body water, the main electrolytes and their normal ranges, which they read before class in about ten minutes on a phone.

In class, learners work in pairs through five patient situations. Each follows the same sequence. First, learners read a situation, such as "Mr. Tran, 64, receives 3 liters of 5% dextrose in water over 24 hours after abdominal surgery." Second, each learner writes an individual prediction on a card: what will happen to serum sodium, to urine output and to the patient's mental status, with one sentence of reasoning. Third, pairs compare predictions and agree on a joint answer. Fourth, the instructor reveals the patient's actual results at 24 hours, drawn from realistic values. Fifth, any pair whose prediction was wrong explains to the class where its reasoning broke down, and the instructor names the principle at stake, in this case that free water dilutes sodium once the dextrose is metabolized.

The five situations build in complexity: dilution by hypotonic fluid, loss of sodium and potassium with a loop diuretic, fluid shift in burns, water retention in syndrome of inappropriate antidiuretic hormone and a combined case in which two processes push sodium in opposite directions. The instructor spends no more than three minutes on explanation per situation; the rest of the time belongs to learners' predictions and corrections.

Evidence That It Changes Learning

Two lines of evidence support the mechanism. In physics teaching, Crouch et al. (2004) compared students who watched classroom demonstrations passively with students who predicted the outcome before seeing it. Students who predicted understood the demonstrations better on a later test, while those who only watched did little better than students who never saw the demonstration at all. Prediction appears to make learners notice where their understanding fails.

Laboratory studies of memory support the same mechanism. Kornell et al. (2009) found that attempting to answer a question before being shown the answer improved later recall, even when the attempt was wrong. A wrong prediction, followed by the correct answer, can therefore be more useful than reading the correct answer without trying.

The evidence from nursing samples is less encouraging and should not be omitted. Harrington et al. (2015) compared nursing students in a flipped classroom with students taught in a traditional format and found no significant difference in examination outcomes. That result is a caution, because the proposal also moves material out of a lecture. However, the conditions differ in a way that matters. The flipped course in that study moved lecture content outside class and used class time for application activities; it did not require learners to commit to a prediction before seeing an outcome. The mechanism this proposal relies on, prediction followed by feedback, was not what that study tested. The null result shows that relocating content does not by itself improve learning, which is consistent with this proposal's argument that the prediction step, not the relocation, does the work.

Comparison With the Recorded Lecture

The comparison is made on four stated grounds.

Effect on reasoning. The lecture presents principles; the exercise requires learners to use them and find out where they fail. On the evidence above, the exercise should produce better reasoning about cause and effect, which is what exam results show is missing.

Coverage. The lecture covers more conditions in 50 minutes than five situations can. The exercise gives up breadth. Conditions not included in the five situations, such as calcium and magnesium disorders, would be covered by the reference sheet and a short reading, which is a real loss for learners who rely on the lecture.

Faculty time. The lecture is already recorded and costs nothing to deliver again. The exercise requires an instructor in class for 50 minutes each term and about twelve hours to write and test the five situations. That is a genuine cost.

Learner time outside class. The recorded lecture takes 50 minutes outside class; the reference sheet takes ten. Given that most learners in this cohort work for pay, the exercise reduces the out-of-class load.

Costs and Implementation

Beyond faculty time, the exercise needs printed cards and a revealed-results slide for each situation. No new technology is needed. The first offering would run in the spring term, with one instructor delivering both sections so that delivery is consistent.

What Would Show It Failed

The course exam already contains six items asking learners to predict an effect from a cause. In the last three terms, the mean score on those items was 47%. If the mean on those items does not rise by at least ten percentage points in the first term of the exercise, while scores on definition items hold steady, the exercise will be counted as a failure, and the recorded lecture will return the following term. The decision will be reported to the course team with the item results, whichever way they fall. If definition items fall by more than ten points, the loss of breadth will be judged too costly, and the reference sheet will be expanded before a second trial.

References

Crouch, C. H., Fagen, A. P., Callan, J. P., & Mazur, E. (2004). Classroom demonstrations: Learning tools or entertainment? American Journal of Physics, 72(6), 835-838. https://doi.org/10.1119/1.1707018

Harrington, S. A., Bosch, M. V., Schoofs, N., Beel-Bates, C., & Anderson, K. (2015). Quantitative outcomes for nursing students in a flipped classroom. Nursing Education Perspectives, 36(3), 179-181. https://doi.org/10.5480/13-1255

Kornell, N., Hays, M. J., & Bjork, R. A. (2009). Unsuccessful retrieval attempts enhance subsequent learning. Journal of Experimental Psychology: Learning, Memory, and Cognition, 35(4), 989-998. https://doi.org/10.1037/a0015729