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Pharmacology Goes Concept-Based: Course Design, Implementation, and Evaluation Amelia Lanz and Rebecca G. Davis

Abstract Although concept-based curricula are frequently discussed in the nursing education literature, little information exists to guide the development of a concept-based pharmacology course. Traditionally, nursing pharmacology courses are taught with an emphasis on drug class where a prototype drug serves as an exemplar. When transitioning pharmacology to a concept-based course, special considerations are in order. How can educators successfully integrate essential pharmacological content into a curriculum structured around nursing concepts? This article presents one approach to the design and implementation of a concept-based undergraduate pharmacology course. Planning methods, supportive teaching strategies, and course evaluation procedures are discussed. KEY WORDS Concept-Based Curriculum – Course Design – Course Evaluation – Nursing Education – Pharmacology Education – Teaching Strategies

number of frameworks exist to support the design and imple- be achieved, the course team engaged in a collaborative effort. This mentation of concept-based curricula in nursing education. article describes our approach for the design and implementation of a A However, in both the planning and transition phases for an concept-based undergraduate pharmacology course and discusses undergraduate nursing pharmacology course, our instructional team teaching strategies supportive of concept-based learning. We also encountered some unique challenges. To begin with, the previous discuss methods used for course evaluation. approach to teaching and learning in pharmacology was based on a conceptual method. General information pertaining to drug class COURSE DESIGN was first considered, and then a prototype drug was used to provide Most educators, as they set out to plan a course, start by considering a specific illustration. Many nursing pharmacology textbooks use this the question: What do students need to know? Thus, an initial step in format to organize drug information. The need to memorize an end- course planning was to identify the essential drug classes to be in- less drug list is avoided and replaced with conceptual learning that cluded in course content. We reviewed several online resources to can be generalized across a drug class. We faced the question of determine the most commonly prescribed medications and those how to infuse a new conceptual framework alongside the one that al- routinely used in clinical settings. We also reviewed the pharmacolog- ready existed for pharmacology. Thoughtful planning was required. ical and parenteral therapies section of the National Council of State A common approach to concept-based course design, the Boards of Nursing NCLEX-RN® Detailed Test Plan as well as the RN concept-disease exemplar model, failed to translate seamlessly to Practice Analysis. We sought faculty input from across the program pharmacology. Moreover, the nursing education literature offered lit- to support curricular integration and obtained varying clinical per- tle in the way of strategies targeted toward teaching pharmacology spectives. We also reviewed the course textbook along with supple- using a conceptual nursing framework. To optimize the course de- mentary resources to support conceptual learning. sign and ensure that the goals of the new curricular model would The next step was to review nursing concepts specified for pharmacology in the program’s curriculum map and arrange them About the Authors The authors are faculty in the College of Nursing, in a sequence to create the course outline. That entailed using the University of Alabama in Huntsville. Amelia Lanz, EdD, RN, CNE, concept outline as the categorizing framework to sort each of the is a clinical assistant professor and traditional BSN curriculum and previously identified drug classes in a logical manner. Example com- instruction coordinator. Rebecca G. Davis, RN, MSN, CNE, is a binations include the concept of perfusion with antihypertensive drug clinical assistant professor. For more information, contact Amelia classes and the concept of fluid and electrolytes with diuretic thera- Lanz at [email protected]. pies and electrolyte replacements. In some instances, disease exem- The authors declare no conflict of interest. plars were needed to provide a context for medication use, such as Copyright © 2017 National League for Nursing medications for osteoporosis or medications used in the treatment of doi: 10.1097/01.NEP.0000000000000188 Parkinson’s disease.

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To further support conceptual learning and help students make favorable outcomes in mind, the concept mapping strategy was connections, we often combined interrelated concepts in the same implemented in future semesters. To further support conceptual class session. As an example, the concept of inflammation was com- learning, one addition was made to the assignment, directing stu- bined with the concept of pain, and both opioid analgesics and dents to include key nursing concepts relevant to the featured drug NSAIDS were considered in this category. When planning for subse- or drug class. quent semesters of pharmacology, we arranged concept-drug class combinations in a sequence to allow each week’s new content to COURSE EVALUATION scaffold onto the concepts learned during previous weeks. Perfusion, The team developed a course evaluation plan to assess outcomes, oxygenation, and fluid and electrolytes serve as an example of this guide future planning, and cultivate the development of the team’s sequencing. In effect, rather than teaching concepts and drug clas- concept-based teaching skills. Evaluation is an essential element to ses as discrete categories, a “building on” approach was imple- promote course and program quality (Oermann, 2017). Drifting away mented to enhance conceptual learning. from a new model and reverting back to “old ways” may happen in the early phases of curricular change. Thus, in instituting the SUPPORTIVE TEACHING STRATEGIES concept-based pharmacology course, regular assessments were Active, student-centered learning is one of the key components of needed to ensure that a conceptual approach to teaching and learn- successful concept-based teaching and learning (Giddens & Brady, ing was maintained. 2007; Stanley & Dougherty, 2010). To meet this recommendation, The course test plan was expanded to include nursing concepts. we use a variety of active learning strategies to allow students to en- Exam results, along with summary reports from a standardized test- gage with and apply medication knowledge most essential for future ing product, helped support the evaluation of course strengths and practice. The majority of these activities are collaborative in nature, weaknesses. One specific use for the data was to assess testing out- allowing students to learn from their peers as well as course instructors. comes related to each concept. For example, in the first semester of Conceptual teaching should require students to manipulate and concept-based pharmacology, the concept of cognition was found organize content, to understand it within multiple contexts, and to to be an area in need of improvement. Clearly, the course team could connect new information to past learning (Giddens & Brady, 2007). discern strategies for improvement in pharmacology, but this finding To begin each course session, a visual map is presented to the class, also supported a concepts appraisal across the curriculum. Because illustrating the concepts for the week. Students are asked to provide testing outcomes pertaining to cognition were found to be weak in examples of how the nursing concepts in the diagram interrelate with other areas as well, collaboration among course teams was under- previously learned concepts and medications. For example, the ses- taken and a collective approach for improvement resulted. sion on medications for nutrition and gastrointestinal disorders follows Currently, focused discussion is conducted by the team at the the class session on medications for fluid and electrolyte imbalances. end of each semester to evaluate both teaching and learning out- Guiding questions are asked to help students make connections and comes. This process has been beneficial in determining what works include points such as: What is the relationship between fluid balance well and what needs to be improved. The results provide clear direc- and perfusion and what is the relationship between gastrointestinal tion for future planning. dysfunction and electrolyte imbalance? These discussions serve to stimulate critical thinking and provide a foundation for subsequent SUMMARY learning activities. Nurses play a key role in the management of medication therapies. To A concept mapping strategy is also used to support active learn- provide safe, effective care, a sound foundation in pharmacological ing and student engagement. Organizing information graphically in knowledge is essential for entry into practice and should receive fo- a concept map promotes deep learning and provides a measure cused attention in the nursing curriculum. This article describes one to assess student understanding (Schwartz & Heiser, 2010). The approach for the development of a concept-based nursing pharma- course team determines which drugs will be included in the concept cology course. Innovative planning was required during course tran- map assignment prior to the onset of the semester. Commonly used sition, but the goals of concept-based learning were maintained. medications and those associated with a narrow margin of safety Positive outcomes for both students and faculty have been achieved generally comprise the list. A rubric is provided noting the key ele- using the course plan presented. ments for inclusion (e.g., patient education, major adverse effects, and pertinent preassessments). Because learners are encouraged REFERENCES to structure map information in ways that align with their thinking, Giddens, J. F., & Brady, D. P. (2007). Rescuing nursing education from content sat- guidelines are kept to a minimum. However, to support learners in uration: The case for a concept-based curriculum. Journal of Nursing Educa- the process, mapping activities are often conducted in class when tion, 46(2), 65-69. instructors are present to provide direction. Oermann, M. H. (2017). Program evaluation: An introduction. In M. H. Oermann (Ed.), In the first semester of implementation, a survey was conducted A systematic approach to assessment and evaluation of nursing programs (pp. 1-6). Washington, DC: National League for Nursing. to gauge student perspectives regarding the concept mapping Schwartz, D. L., & Heiser, J. (2010). Spatial representations and imagery. In K. Sawyer assignment. Results indicated that 80 percent of the cohort (Ed.), The Cambridge handbook of learning the learning sciences (pp. 283-299). (n = 93) believed the activity was beneficial to their learning. Stan- New York, NY: Cambridge University Press. Stanley, M. J., & Dougherty, J. P. (2010). A paradigm shift in nursing education: A dardized test results over two semesters suggested that drugs new model. Nursing Education Perspectives, 31(6), 378-380. doi:10.1043/ included in the strategy correlated with positive scores. With these 1536-5026-31.6.378

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