T. Peters Nursing Case Study Project Final

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Running Head: Nursing Case Study Project






Nursing Case Study
Instructional Design Project
Tara Peters, MSN
Ed Tech 503
Boise State University














Nursing Case Study Project 2

Table of Contents

Synthesis/Reflection Paper 4

Part 1. Topic 5
1a. Stated learning goal 5
1b. Description of the audience 5
1c. Rationale 5

Part 2. Analysis Report 6
2a. Description of the needs 6
2a1: Needs assessment survey 6
2a2: Needs assessment data report 6
Table 1: Student report of mastery of prior learning 7
2b. Description of the learning context 7
2b1: Learning context 8
2b2: Transfer context 8
2c: Description of the learners 8
Table 2: Students by gender and age 9
2d: Task analysis flow chart 10
Figure: Learning objectives flow chart 10

Part 3. Planning 12
3a: Learning objectives 12
3b: Objectives and assessment matrix table 13
3c: ARCS Table 15

Part 4. Instructor Guide 18

Part 5. Learner Content 23
5a: Learning materials 23
5b: Assessment materials 23
5c: Technology tool justification 23

Part 6. Formative Evaluation Plan 24
6a: Expert Review plan 24
6b: One-to-One evaluation plan
24
6c: Small Group evaluation plan 24
6d: Field Trial evaluation plan 25

Part 7. Formative Evaluation Report 26
7a: Evaluation survey 26
7b: Report the results of the expert review 29
7c: Comments on change 29

Nursing Case Study Project 3

Part 8. AECT Standards Grid 30

References 32

Appendices 33
Appendix A 33
Appendix B 34
Appendix C 36
Appendix D 40





































Nursing Case Study Project 4

Synthesis Reflection Paper

It occurred to me part way through my final project that the instructional design (ID)
process can be compared to an iceberg in that only a small portion of the work of any
instructional design process is visible to most observers. While the educated or experienced
observer can look at the small visible portion and understand that they are only seeing about 10%
of what makes the project work, or of the iceberg, the inexperienced or uninformed observer
cannot. The instructional design project I completed is much the same. An inexperienced
observer could walk into any of instructional settings described by me or by any of my fellow
students and see a polished, smooth-flowing learning process taking place. Little do they know
the hours of thought and volumes of written preparation that support the final project, making it
float effortlessly before their eyes!

I, too, had no idea just how much work goes into a really well-constructed instructional
design project. While I knew when I started teaching that I had much to learn, I simply had no
idea how much preparatory work goes into a well-designed learning activity. Our first ID project
in this class made me consider how to think about the process and introduced me to multiple
approaches to establishing the framework of any instructional design project. Like the person
who knows nothing of icebergs and thinks that all they see is all there is, I not only did not know
that I needed a framework (“winging it” had served me well up to this point) or that I needed a
different framework for different situations. (Gustafson and Branch, 2002)

Our second project really allowed me to see the ID process from multiple viewpoints as I
took on a role and then tried to view the entire project and its component parts from multiple
perspectives. In addition, I had to defend my position and critique my classmates’ work from a
logical, well-grounded position. I have truly enjoyed learning how to systematically approach
instructional design. As I stated previously, I had been winging it in the sense that I thought
about what I was doing, but at the same time I has a suspicion that I was missing the boat on one
or more issues. Now, I feel that I have some theoretical framework to help guide my thinking as I
design learning activities.

I am already using what I have learned in this class. I am better prepared to help new
instructors prepare lessons and learning activities and I can explain to them why some projects
need to be structured as they are. Most have never been exposed to these ideas (they are nurses,
not educators, after all) so anything I can offer them in terms of guidance or resources is most
welcomed. As I transition to the field of educational technology, I am sure I will utilize what I
have learned in this and all of my classes along with my nursing education to develop relevant,
efficient and current learning resources. I am particularly interested in making an impact in the
area of competency based eLearning because I can see that the brick and mortar time-based
educational experience is available to fewer and fewer students over time and is largely
dependent on available financial resources, but that education is still the key to progress and
achievement. Education is still the great equalizer and it is a pity that so many bright, motivated
students of all ages are not able to reach their potential due to lack of access to affordable,
quality, non-location-dependent education.


Nursing Case Study Project 5

Part 1. Topic
1a. Stated learning goal
Second semester nursing students will be able to accurately apply their knowledge of the
underlying causes of, effective nursing care for, and clinical manifestations of Diabetes Mellitus
(DM) to a project-based (case scenario) learning activity after 3 hours of classroom instruction.
1b. Description of the audience
The target audience is second semester nursing school students who are currently
enrolled in the Medical-Surgical Nursing class at Mountainland Applied Technology College
(MATC). These students are approximately four weeks away from graduation and have learned
and had the opportunity to apply principles of patient care in a variety of healthcare settings prior
to being presented with this learning activity.

1c. Rationale
The case study project will emphasize newly learned information about caring for
patients with DM and will require students to synthesize this new information with previously
learned material covering basic patient care, laboratory and diagnostic testing, and the nursing
process, or ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation), and any
other previously learned material or skills the students find relevant to the case study.
Nurses must have critical thinking skills and must be able to sift through large amounts of
information to determine what is relevant and what less so as well how to prioritize relevant
information in order to provide appropriate nursing care and improve patient outcomes. While
the clinical setting may be the best setting for learning patient care, the concepts behind patient
care take time and targeted guidance to learn well. Therefore, allowing students to work through
a case study and try to apply both new and previously learned material to an unknown situation
is an effective way to teach students prior to allowing them to care for real patients. Students are
free to think through problems without the risk of injuring a patient and they can ask questions as
they work through the case. In addition, instructors are available for guidance and to correct
misconceptions students may have while in a supportive learning environment.
The learning in this project is primarily generative, though a small amount of the new
learning, approximately 10%, will be supplantive. Students will be required to memorize a few
lab values and basic information about DM but the majority of their learning will be generative
because they are not passive learners during this activity. The students will be actively engaged
in applying what they know to a previously unknown situation, prioritizing and justifying their
actions, and they will be reflecting on their actions and their patient’s outcome based on the
choices they have made.
This learning goal is an intellectual skill according to Gagne (Smith and Ragan, 2005),
specifically problem-solving, and thus employing a problem-solving instructional strategy by
utilizing a case study is appropriate. The case study can be presented as relatively well-defined to
begin with but as the instructor provides the class with patient status updates the case can
become more complex and ill-defined. This approach will allow the instructor to gauge the
students’ level of understanding and help students correct misconceptions as the difficulty of the
case increases. In addition, this progression from relatively well-defined to ill-defined will allow
the instructor to match the case difficulty to the students’ levels as well as allow the instructor to
Nursing Case Study Project 6

spend more time developing concepts the students need to develop and less time working on
concepts they clearly understand.

Part 2. Analysis Report

2a. Description of the needs
A learning need exists because students will care for many patients with diabetes mellitus
(DM) during the course of their career, so it is essential that they are familiar with the disease
and how it impacts patient health. While the students will have been introduced to various
aspects of the nursing process and patient care, they will benefit from having the opportunity to
apply their learning to an unknown situation in a safe environment prior to having to demonstrate
their knowledge and critical thinking skills in the real world context of clinical rotations or their
work place.

2a1: Needs assessment survey
The needs assessment survey (Appendix A) was handed out to 21 second semester
students to complete at the end of their Medical-Surgical Nursing class on March 25, 2013. The
students were told the purpose of the survey and that completing it was voluntary and that they
should not put their names on the survey form. 18 of 21 students participated in the survey.
While an instructor may know the answers to many of these questions, an instructional
designer would not. Not only might the survey tool be useful for gauging the students’ starting
point for the planned learning activity, it may also serve as a cue to the students that content
requiring this knowledge might be forthcoming in class and, thus, a brush up on areas where they
may feel their knowledge or skills are weak would be beneficial to them going in to this project.

2a2: Needs assessment data report
All 18 respondents were able to identify the correct steps of the nursing process and were
able to place them in the correct order, and all students were able to explain why they needed to
assess prior to acting. Students were less clear about how elevated blood sugars effect cellular
functioning or why it inhibits wound healing, though all were sure that it did and demonstrated at
least a partial mastery of the concepts involved. While all the students report caring for multiple
patients with diabetes during their clinical rotations, twelve were able to affirm that they had
been presented with lab or simulation scenarios involving patients with diabetes as the subject’s
primary or secondary medical diagnosis. Of the 18 students who responded to this question, five
rated their understanding of proper nursing care for patients with DM as average, 10 rated
themselves as very good and 3 rated their knowledge of nursing care for diabetic patients as
excellent.










Nursing Case Study Project 7

Table 1. Percentage of students reporting experience or mastery of prior nursing school experiences.
Total number of respondents 18 (4 male, 14 female)




Because case studies are a regular part of their educational experience in the practical
nursing program, all the students reported prior experience with case studies and reported that
the experience is generally helpful to them because it allows them to collaborate with their group
in class, and the case studies provide context for what they have learned. Two students
commented that the case studies allowed them the chance to make connections between aspects
of the patient’s care they might not have made otherwise, and the majority indicated that case
studies in one class had helped them either in other classes or in clinicals.
The remaining questions on the survey dealt with utilizing Maslow’s hierarchy of needs
to prioritize care for their patients and developing appropriate nursing diagnoses for their
patients. While all the students were able to identify how Maslow’s can help them figure out
what is most important or which patient needs to be seen first, they were less adept at explaining
why their interventions should be patient-specific, and fewer than half the students gave a
satisfactory response to question 15 which asked them to identify the essential elements to a
nursing diagnosis. Considering that these concepts have been covered since the second week of
the program, the nursing instructors were a bit mystified as to why the students are still having
trouble with these concepts and agreed that the results warrant examination.

2b. Description of the learning context
Nursing program instructors have noticed an increasing tendency for students to want to
“learn by bullet-point” and favor memorization over in-depth critical thinking. Since the bulk of
a nurse’s work is at the application or higher levels, this type of learning will not serve to
develop a competent, effective, safe nurse. Instead, nursing students need to be able to think
critically, apply what they know to new situations.
0
20
40
60
80
100
120
Male Female
Prior Case Studies
Patients with Diabetes
Able to Utilize Maslows
State Elements of Nursing
Diagnosis
Nursing Case Study Project 8

The discrepancy model is the appropriate method for conducting a needs assessment in
this case because both didactic and clinical instructors have noticed that students want to
memorize content but they are increasingly less successful at actually applying what they should
know to patient care scenarios in the Sim lab and in the clinical setting. Therefore, there appears
to be a discrepancy between what is and what should be. Case studies require learners to apply
the content and concepts they have learned to new situations, thereby giving them an opportunity
to apply what they know as they consider multiple pieces of information and changing
conditions. Discrepancies in performance can be due to failure to master previously taught
content and concepts, failure to grasp new content, or it can be attributed to other factors such as
motivation or lack of time to complete projects.

2b1: Learning context
The learning activity will be conducted in the Practical Nursing program’s second
semester classroom on the MATC campus. The room is well-lit and has adequate seating for up
to 30 students, and is equipped with a large white-board, an overhead projector, viewing screen
and a computer for use by the instructor. The students may bring their portable electronic devices
to class and plenty of electrical outlets are available for students who want to charge their
device’s batteries.
All nursing students are adults who have completed prior coursework in anatomy,
physiology, English and math as prerequisites to entry into the program, and all have completed
their Certified Nursing Assistant (CNA) classes and are certified in the State of Utah. In addition,
all nursing students have taken a CPR course and most have worked as a CNA in a hospital or
nursing home prior to enrolling in the practical nursing program.
The nursing students have had to compete academically to be accepted into the nursing
program and so all appear to be motivated to succeed. However, many students are over-
scheduled due to family, work and the ill-advised habit of trying to complete the nursing
program while taking prerequisites for more advanced nursing programs to which they hope to
gain entry after they complete the practical nursing program. Thus, what is in fact a reasonable
amount of work for any entry-level nursing program is felt to be excessive by students because
of other issues and demands outside the classroom. Instructors feel these problems can contribute
to students’ tendency to fall back on old habits such as being task-oriented rather than learning-
oriented, and attempting to simply memorize content rather than master and apply concepts.

2b2: Transfer context
The students will be able to apply their knowledge and skills when caring for their
patients and they will be able to utilize the critical thinking skills they are developing when they
take the National Council Licensure Examination for Practical Nurses (NCLEX-PN) after
graduation. It is not enough that nurses possess knowledge or that they can master the art of
taking multiple choice exams such as the NCLEX-PN. Nurses must also be able to apply what
they know to patient care. Thus, the learners must be able to apply their learning in two contexts
in order to become licensed and in order to function as safe, effective nurses.

2c: Description of the learners
All of the current 21 second semester nursing students are adults over the age of 18 who
have completed prior coursework in anatomy, physiology, English and math as prerequisites to
entry into the program, and all have completed their Certified Nursing Assistant (CNA) classes
and are certified in the State of Utah. In addition, all nursing students have taken a CPR course
Nursing Case Study Project 9

and most have worked as a CNA in a hospital or nursing home prior to enrolling in the practical
nursing program. While most of the students are females in their 20’s, the class does include
several adults over the age of 30, and one in her 50’s, and four males. In addition, the current
class consists primarily of white non-Hispanic students who are members of the LDS church
though two of the male students are Hispanic, one from Bolivia and the other from Mexico. Six
students have associates degrees in another field, 2 have Bachelor’s degrees, and one was an
attorney in his home country.

Table 2. Percentage of second semester practical nursing students by gender and by age.




The planned learning activity will take place in week 30 of the 32 week program. As
such, the learners will all have already been presented with all the basic skills and concepts they
will need to complete this activity successfully by the time they begin working on this case
study. However, it is not enough that information and ideas have been presented to the students.
They also need the opportunity to apply their knowledge in a safe environment where they can
learn from their mistakes and the mistakes of others. The student’s learning will also be
enhanced by allowing them to link new information to previously learned information and by
allowing them the time to think issues through and make connections.
















Student Gender
Male - 4
Female - 17
Student Age
18-30 years
31-52 years
Nursing Case Study Project 10

2d: Task analysis flow chart

Learning Objectives #1 - 4.1








Read Case Study Gather lab data
LO #1 ID 5 required lab
results
Was lab data correctly
Identified?
If yes, continue. If not, seek
information.
LO 1.1.1
Able to distinguish relevant from
irrelvant lab data?
If yes, continue.
If not, seek information.
LO 1.1.2
Explain how lab results drive
patient care?
If yes, go to LO #2.
If not, seek information.
LO #2
Explain use of BS checks in
patient care.
If yes, go to LO #3.
If not, seek information.
LO #3 ID critical lab values
If yes, continue.
If not seek information
LO #3.1 Predict change in
nursing care
If yes, continue.
If not seek information
LO #3.2 Give critical lab value
report
If yes, go to LO #4
If not seek information
LO #4 Prioritize care per
Maslow's
If yes, go to LO #4.1
If not seek information
LO #4.1 Determine priority
nursing diagnosis.
If yes, go to LO #5
If not seek information
Nursing Case Study Project 11

Learning Objectives #5 - 6.1
How to Seek Information Flow Chart

















LO #5 Construct 5
interventions with
rationales. If yes,
continue to LO #6. If
not, seek
information.
LO #6 Apply
interventions and
anticipate results. If yes,
continue. If not, seek
information.
LO #6.1 Are
interventions patient
specific?
Successful Completion
of NIDDM Case Study
Review your notes from
this class
Consult your lab and
diagnostic handbooks.
Consult your textbook.
How to Seek
Needed Information
Review your notes from
other classes.
Consult with your group
members
Consult with your
instructor
Nursing Case Study Project 12

Part 3: Planning

3a: Learning objectives

1. Accurately identify 4 of 5 lab results needed for accurate assessment of the diabetic
patient in the case study. (This number can be changed up or down to reflect the
complexity of the case appropriate to students’ current level.)
1.1. Presented with a list of lab results, students will be able to distinguish
relevant labs results from irrelevant lab results.
1.2. Students will be able to explain the significance of both relevant normal
and abnormal lab results to show how those results drive patient care.
2. Explain how blood sugar checks and glucometer can be used effectively in the care of
a patient with NIDDM.
3. Accurately identify the critical lab value in the case study.
3.1. Analyze the relevance of the critical value included in the case study.
3.1.1. Predict changes in nursing care related to the critical lab value.
3.2. Articulate the procedure for reporting critical lab values including to whom
the results must be reported, in what time frame, and the charting requirements.
4. Prioritize patient care based on Maslow’s hierarchy of needs.
4.1 Determine the priority nursing diagnosis, written in proper form.
5. Construct five nursing interventions relevant to the priority nursing diagnosis, with
rationales.
6. Apply the nursing interventions and describe the anticipated results of those
interventions.
6.1 Demonstrate how each nursing intervention is patient specific. Include your
nursing actions, and the anticipated results.

3b: Objectives and assessment matrix table
Learning
Objectives (a)
Bloom’s
Taxonomy
Classification
(b)
Format of
Assessment
(c)
Description of
test form (d)
Sample items (e)
1. Accurately
identify 5 labs
needed for
accurate
assessment of the
diabetic patient.
(This number can
be changed up or
down to reflect
the complexity of
the case
appropriate to
Comprehension Written Constructed
answer
Given your thoughts at this time,
which labs can you anticipate the
provider ordering on this patient?

Nursing Case Study Project 13

students’ current
level.)
1.1. Presented
with a list of lab
results students
will be able to
distinguish
relevant labs
results from
irrelevant lab
results.
Comprehension
Application
Written Constructed
answer
Given the lab results at this time,
which are relevant to your patient
care and why?
1.2. Students will
be able to explain
the significance of
both relevant
normal and
abnormal lab
results and how
those results drive
patient care.
Application
Analysis
Written Constructed
answer
Explain why the lab results, both
normal and abnormal, are relevant.
How do the labs drive the care for this
patient?
2. Explain how
blood sugar
checks and
glucometer can be
used effectively in
patient care.
Application Written Constructed
answer
How will BS checks with a
glucometer help you assess your
patient? Explain your reasoning.
3. Accurately
identify 2 of 2
critical lab values
in the case study.
Comprehension Written Constructed
answer
Which, if any, lab values are critical?
3.1. Analyze the
relevance of the
critical values
included in the
case study.
Analysis Written Constructed
answer
What are the potential outcomes to
this patient if the critical lab values
are not addressed within the next
hour?
3.1.1. Predict any
changes in
nursing care
related to critical
lab values.
Application
Analysis
Written Constructed
answer
Examine how you will change your
nursing care of this patient, if at all,
based on the critical lab values you
have received.
3.2. Articulate
the procedure for
reporting critical
lab values to
Application Written Constructed
answer
What are you obligated to do once
you receive critical lab values?
Include all steps from the time you
receive the critical lab value through
Nursing Case Study Project 14

include to whom
the results must be
reported, in what
time frame, and
charting
requirements.
the final step in the process.
4. Prioritize
patient care based
on Maslow’s
hierarchy of
needs.
Analysis
Synthesis
Written Constructed
answer
Apply Maslow’s to this patient case
and explain your reasoning.
4.1 Determine the
priority nursing
diagnosis, written
in proper form
Analysis Written Constructed
answer
Based on the facts of the case and
Maslow’s, state the priority nursing
diagnosis for this patient, written in
proper form.
5. Construct three
nursing
interventions
relevant to the
priority nursing
diagnosis, with
rationales.
Analysis
Synthesis
Written Constructed
answer
State 5 patient specific nursing
interventions relevant to the priority
nursing diagnosis and clearly explain
your rationales. Be sure to include an
explanation of how you would
evaluate the effectiveness of your
interventions and why you chose
these interventions and methods of
evaluation for this specific patient.
6. Apply the
nursing
interventions and
describe the
anticipated results
of those
interventions.
Application
Analysis
Written Constructed
answer
What results do you anticipate from
each intervention? Why?
6.1. Demonstrate
how each nursing
intervention is
patient specific.
Include your
nursing actions,
and the
anticipated
results.
Analysis Written Constructed
answer
Did your results differ from what you
might expect (textbook patient
responses)? If so, how, and what
might have been the cause. What
might you do differently next time?

While I have stated that these objectives would be met via a constructed answer, it is also
quite possible to have students demonstrate mastery of some of these objectives verbally such as
reporting their group’s ideas or diagramming a patient on the board for the rest of the class. In
Nursing Case Study Project 15

other words, the constructed answer may be something other than a written narrative. However,
some students may not actively participate in classroom activities to the extent it is possible to
really gauge their mastery of the material. In that case it may be best to use a combination of a
constructed answer assessment types and compare those results with the students’ clinical
performance to get an accurate assessment of the students’ functioning. In addition, students are
strongly encouraged to be self-sufficient when seeking information. Not only does this encourage
them to learn where to find reliable information but it discourages the over-use of the instructor
as their main resource. When the students move from the classroom to the workplace they will
no longer have a ready source of answers like their instructor, so requiring the student nurse to
exhaust all other resources prior to asking for the instructor’s help will encourage them to retain
previously learned information and will develop their research skills thus enabling them to
function effectively, safely, and independently.

3c: ARCS Table
ATTENTION
A.1 Perceptual Arousal
>Announce that today’s class will consist of a short review session followed by collaborative or
individual work on a case study. It is assumed that the students have read the relevant materials
prior to class as instructed.
>Review pertinent information and concepts covered in previous classes to be covered in the
case study followed by the review of diabetes related information covered in their reading
materials for this activity.
>Demonstrate via a short example case study how previously learned and newly learned
knowledge can be used to solve patient care problems.
A2. Inquiry Arousal
>Students will be asked to answer prompts from the instructor regarding their care of patients
with DM in their previous clinical rotations.
>Students will be asked to respond to instructor inquiries regarding previous examples of patient
care and how the new information might have helped them provide more competent, patient-
specific care.
A3. Variability
>Instructor will intersperse the lecture and review time with any combination of Power Points,
NCLEX-style questions, and exemplars requiring “audience-participation” to keep students
engaged.
>Learners will have the choice of working in a group or working alone in solving the case study.
Nursing Case Study Project 16

One paper will be graded for each group and the same score assigned to all regardless of the size
of the group (limited to 1-4).

RELEVANCE
R1. Goal orientation
>The instructor will provide the students with the goals for the learning activity, which involves
applying previously learned and new knowledge to a new case study involving an adult patient
with DM.
>The students will be provided with the class objectives.
> The instructor will review the goal and objectives and illustrate how this learning activity
applies to their future practice as nurses who will care for patients with DM.
R2. Motive matching
>The instructor will conduct a brief survey of the class to determine if the students have any
additional related information/concepts they would like to have covered during the class.
>The instructor will give examples of how what the students will learn in this class will apply to
future patient care situations the students will likely encounter by giving examples from real-life
experiences.
R3. Familiarity
>The instructor will ask students to recall their previous case studies and remember what
strategies worked well for them and what did not so they can use their time effectively.
>The instructor will be available during the class to guide students, and students will be
reminded they need to be as self-sufficient as possible.

CONFIDENCE
C1. Learning requirements
>The instructor will provide each student with a rubric and a clearly defined set of questions so
students will understand the case study requirements clearly.
>Each student will be provided with a copy of the case study for their own use during class.
Students can keep as the case study and reference materials for future reference.
Nursing Case Study Project 17

C2. Success opportunities
>The instructor will guide students to appropriate resources or will provide assistance when
students have questions they cannot immediately answer on their own.
>The instructor will provided feedback to each group or individual at certain predefined steps in
the process as well as whenever asked.
>Students are given the opportunity to have their work reviewed prior to turning it in for a score
and will be provided the opportunity to correct any issues before submitting it for a final score.
C3. Personal control
>Students will be reminded that as adult learners they may use their time as they see fit but that
they will need to submit their case study for a score within 60 minutes of the end of class.

SATISFACTION
S1. Natural consequences
>All students will have the chance to work alone or in a group as they choose in order to have
the greatest opportunity for personal success.
>All students will have an equal amount of time to complete and submit their work.
S2. Positive consequences
>Students have the opportunity to apply important nursing concepts to the care of a diabetic
patient in a low-risk environment.
>Students have the opportunity to submit their work after it has been reviewed in order to correct
misconceptions or oversights prior to scoring.
S3. Equity
>Instructor feedback will be given based on the rubric which was provided to the students at the
beginning of the project.
>Students will be reminded that their success as nurses is a primary goal of this learning activity
and has such they will be held to the standards indicated in the rubric but they will also be given
ample opportunity for research and inquiry prior to submitting their work.


Nursing Case Study Project 18

Part 4. Instructor Guide
Introduction (30 minutes)
Gain Attention
Announce that the class is beginning and that everyone needs to shut off their cell phones
and give their attention to the instructor. Shut the door to the classroom to minimize outside
distractions.
Inform Learners of Purpose
Inform the students that the goal of the lesson is that they, upon completion of the
learning activity, will be able to accurately apply their knowledge of the underlying causes of,
effective nursing care for, and clinical manifestations of Diabetes Mellitus (DM) to a project-
based (case scenario) learning activity after 3 hours of classroom instruction, review, and
participation in the active learning activity (case study).
The instructor will explain that in order to prepare them to meet that goal they will be
given the opportunity to combine their previous learning with the newly learned material in order
to answer questions involving a case study of a diabetic adult patient.
Stimulate Learners’ Attention/Motivation
Let students know that the purpose of the learning activity is to give them the chance to
practice what they know by applying their knowledge and critical thinking skills to a case study
in a safe environment prior to providing nursing care to similar patients in the clinical setting.
Since all of the students in the class are likely to have cared for diabetic patients at
clinicals prior to this class, the students should be asked to think back to any previous experience
and then write down two things that they would have liked to have known at that time about
caring for a diabetic patient, but did not, that they would like to know now by the end of the
lesson.
Tell the students to keep these questions because they will be referring to these questions
at the end of the class.
Preview the Learning Activity
Hold up a copy of the case study, the objectives and the rubric and let the students know
that they will each receive a copy of these pages so they will have clear instructions and
expectations in front of them the entire time they are working on the case study. Do not give
these items to the students prior to the content and concept review, however, as this will merely
prove to be a distraction and will interfere with their ability to focus on the review.
Nursing Case Study Project 19

Let the students know that the instructor will review relevant knowledge and concepts
with them prior to starting and that the instructor will also be available during the entire class for
guidance. Once the relevant material has been reviewed the students will be allowed to break off
into groups or work individually to complete the case study.
Body (1 hour 45 minutes)
Stimulate recall of prior knowledge
Review relevant, previously learned content with the students by asking them questions
such as “what is the first step in the nursing process,” “why do we assess before we act” or “who
can tell me why Maslow’s helps us prioritize patient care?”
This type of questioning serves two purposes. First, it allows the instructor to assess the
classes’ baseline and it serves to get students thinking about the ideas they will need to use in
order to answer the case study questions.
Next, the instructor can ask questions about the content from the reading material. The
expectation is that the students have read and understood the material and that the instructor is
not there to deliver basic content but rather to review it and clarify misconceptions or elucidate
pertinent aspects of the material and related concepts.
The instructor should touch on the main points of the materials and related concepts and
guide students through the process of understanding how DM affects patients.
Present information and examples
The instructor can then give at least 2 examples of how DM can change the nurse’s care
of a specific patient by giving examples of standard patient care that must be changed once the
health care team learns the patient has DM.
The conversation should start out with the general concepts being covered and should end
with specific examples in order to show students how to apply concepts to specific patients.
The instructor will inform the students that the rubric asks for patient specific, not
textbook, answers to questions. The instructor should ask for and answer questions regarding the
learning, but should also take care to help the students discover answers for themselves rather
than just providing information for them.
Gain & Direct Attention
The instructor should then hand out the rubric, objectives and the case study and go over
each item with the students so they will have a clear overview of the assignment and
expectations.
Nursing Case Study Project 20

Answer any questions they may have.
Remind the students that the expectation is that this case study be completed within 60
minutes of the end of class, no exceptions. This should give them plenty of time to review the
case study and answer the questions. This time frame also provides adequate time to research
materials, lecture notes, or textbooks as needed and to prepare their work for submission.
Remind students that the expectation is that the instructor is the resource of last resort and
that they will need to look in every possible available source prior to asking the instructor for
direct answers, though the instructor is always available to help them think a problem through or
organize their approach to a problem.
Tell the students that they can work in groups or individually as they choose and that the
instructor will review their answers and give them guidance as they work through their case
study. Remind the students that there will not be enough time at the end of class for the instructor
to check all work from beginning to end nor will there necessarily be enough time for them to
correct all errors and still submit their work on time. Students should be told that they are
responsible for using their time wisely and efficiently.
Each group will turn in one care plan with the names of all group members and all the
members will receive the same score. Individuals will turn in their case study for themselves, and
no student may have their name on more than one submission.
If at any time any individual feels that their group members are not working in a
collaborative, goal-directed manner, that student can simply inform the instructor they are
breaking off from their group and that they will complete the work on their own.
Guide and Prompt Use of Learning Strategies
The students may work on the case study using their own strategies with the
understanding that the instructor is available for guidance as needed.
The instructor should check in with each group or individual multiple times during class
and assess whether or not the students are utilizing effective strategies for answering the case
study questions. The instructor should offer guidance, encouragement and reinforce their
successes.
If the students are struggling then the instructor can assess exactly where the students
may be getting off track or where their problem-solving strategies are not effective and offer
guidance.
Remind the students to think through problems using the nursing process, the ABCs and
Maslow’s because consistent and appropriate application of these principles will help students
deal with previously unknown issues in the real world of nursing.
Nursing Case Study Project 21

Remind students, too, that if they are having difficulties with problem-solving because
they do not have enough information, they need to stop and get the needed information before
they move on in the case study.
Provide for and Guide Practice
The students will work on their case study for as long as it takes for them to complete the
task, up to 1 hour and 45 minutes.
Students are not allowed to rush through their work and leave early. If students want to
leave early they must submit their final product prior to leaving class.
Collect student work as individual or groups finish and compare the work to the rubric.
The students can finish early and have their work checked for major errors so they will have time
to make corrections. Make it clear to the students that their work is being reviewed for major
errors, and that it is not carefully scored at this time.
If the work is lacking then return it with comments for review and correction. Provide
guidance as needed. Remind the students to review the assignment and rubric as needed.
Provide Feedback
Review the students’ work at several points during class as described above. The
instructor should circulate among the groups to increase accessibility and approachability.
The instructor should make major corrections during class, but certainly within 30
minutes of the end of class in order to give all students time to make corrections prior to
submitting their work if needed.
No sooner than one hour after the end of class, the instructor will score the submissions
and assign points according to the rubric and then enter the scores in the LMS.
Conclusion (30 minutes)
Provide summary and review
Prior to dismissing class, the instructor should review the students’ questions they were
asked to write down at the beginning of class. Were those questions answered? Allow the
students time to answer. One very effective method of formative assessment and positive
reinforcement is for the instructor to read representative questions to the class and ask for input
from the class. If questions still remain, ask the students to research the questions and present
their findings at the beginning of the next class.
Nursing Case Study Project 22

The instructor can assess whether or not the students were able to learn what they wanted
to know, and can also ask if they discovered anything that they now realize was important but
may not even have known to ask at the beginning of the class.
Allow approximately 15-20 minutes for this discussion, or more if time allows.
Transfer learning
Remind students of what was learned and how this new knowledge will translate to their
workplace once they graduate and are working as nurses.
Provide Remediation and Closure
Opportunities for remediation have been provided throughout the class, but students may
benefit from more discussion now if time permits, and are also invited to speak to the instructor
individually if desired.
Once all the case studies have been reviewed for major errors the students may leave with
the understanding that their final product must be submitted within 60 minutes of the end of
class.
Assess Learning
Learning will be assessed based on the written case study and rubric as discussed above.
Provide Feedback and Remediation
The students’ work, the graded rubric, and comments should be completed and returned
to each student within one week.
Meet with any students who were exhibiting difficulties grasping or applying the
information so they can receive guidance or remediation as needed.
Part 5. Learner Content
5a: Learning materials
The case study will be provided to the students, along with an answer sheet in both
printed and electronic form in order to accommodate students who prefer to work with paper or
who do not have a portable device available during class. Students are required to complete their
work and submit it electronically. The case study, along with its worksheet and the rubric, is
attached as Appendix X.
The students have access to their textbooks and their lab manuals which were purchased
at the beginning of the school year, and they have their class notes from this or previous classes
to use as reference materials as well. The students are required to read the assigned materials
Nursing Case Study Project 23

prior to class and come to class prepared to apply what they have learned to the case study. In
addition, the instructor will spend some time at the beginning of class reiterating the main points
of the reading, making connections to clinical practice by drawing from their own experiences as
a nurse, and answering questions and correcting any misconceptions that the students might
have. Instructors are free to use lecture notes, Power Points, outside resources or to simply speak
extemporaneously.
5b: Assessment materials
The case study answer sheet will serve as the main assessment. Once the students have
completed the case study and the accompanying work sheet in the allotted time period they will
turn in their final product according to the directions. The instructor will grade their submissions
according to the rubric, enter their scores in the LMS and return the students’ work no later than
the beginning of the next class period the following week.
5c: Technology tool justification
This case study requires students to complete and submit their work online via email to
their instructor. Experience has taught the faculty that this method is more reliable than
submitting the assignments within the current LMS and that the time and date stamp is accurate.
In addition, should the instructor not receive an email, it is relatively easy for the student to show
when it was sent. Students are encouraged to store all of their work “in the cloud” in addition to
on their hard drives in order to protect against loss of data for any reason. In terms of preparing
students for the workplace, most facilities do not use paper records or are steadily moving away
from paper. Students must be able to use computers, email, and the Internet in order to be
effective at their jobs and competitive in the marketplace if they hope to obtain and retain
employment in almost any setting. All students will have access to their assigned Google
Chromebook computers and the Internet while in the classroom, though the Chromebooks cannot
leave the nursing department classrooms. Additionally, students can use the computer labs at our
school.
Other than the expectation that students will complete and submit their work online, this
project is relatively low-tech in that it relies heavily on textbooks, lab manuals, previously
received materials from any class, and the students’ own notes. Students can utilize outside
resources they locate independently, but that is not required for this learning activity at this time,
though the SME suggested the students be allowed to utilize the Internet to search for sources
and as a way for instructors to reinforce ideas of evidence-based practice. Please refer the SME’s
comments in Section Seven beginning on page 25 for details.


Nursing Case Study Project 24

Part 6. Formative Evaluation Plan
6a: Expert Review plan
Tamra Carley served as the subject matter expert (SME) reviewer for this project. Tamra
is a Masters-educated registered nurse with an extensive background in both nursing and
education. Not only does Tamra have a background in nursing education, curriculum
development, and instructional design but she is currently a PhD candidate in education. She has
graciously agreed to review this plan and the associated materials, and to complete the
questionnaire I have provided her. Her responses are summarized in Part 7 below. The lesson
would be revised based on the SMEs comments prior to presenting it to the one-on-one
evaluators.
6b: One-to-One evaluation plan
I would provide the course materials to our two medical-surgical instructors and two to
four students, one or two from the top 25% of the class and one or two from the bottom 25% of
the class, and speak to them each individually in private one-to-one meetings in order to gain the
perspective of both learners and instructors regarding a number of main points. I would like all
of the participants to speak to issues such as completeness and clarity of the materials and
instructions, if they felt the time allotted for the various tasks is appropriate, and whether or not
they feel as though the learners should be able to accomplish this learning activity when their
previous learning and the current learning materials are combined. Do students feel that their
prior coursework coupled with the current lesson adequately prepares them for the learning
activity? If not, what do they think is lacking or what suggestions might they have for making
certain students are properly prepared? Have the materials been presented but not learned, or has
the missing material(s) or concept(s) not been presented at all? If deficiencies are noted, the
faculty can review the curriculum map and make adjustments as needed. The lesson will be
revised as needed prior to presenting it to the small group evaluators.
6c: Small Group evaluation plan
A small group of four or five students would be provided the instructions and materials
and then allowed to work through the case study on their own without interference. I would
select students representing the top 25% and the bottom 25% of the class in order to get a variety
of perspectives from students of varying abilities. Just as the learning activity is written, a faculty
member could be present to help guide students as needed, but the emphasis would be on self-
reliance and the students’ own efforts. I would not act as the faculty member and would not be
present in order to allow the process to unfold without interference from the designer. While
having the instructional designer present to observe would be beneficial, it must be remembered
that I am also the program director and as such my presence could make students self-conscious
Nursing Case Study Project 25

and impact their behaviors. However, I would like to film the process in order to have the raw
footage and dialogue available to me for analysis later on.
Just as with the one-on-one participants, I would ask the small group members if they felt
adequately prepared for the activity, if the time allotted was appropriate, and if they felt the
instructions were clear. Did you understand how you would be scored and were the instructions
clear about when and how to submit your work for evaluation? Have you learned in your
previous classes what you needed to know in order to successfully complete this case study? If
not, what information or concepts did you feel were lacking? The instructor would observe, as
well, and note how the students appeared to be doing, if they noticed any issues regarding critical
thinking, the students’ ability to apply the nursing process, the inability to apply general
knowledge to a specific patient case and so forth. The students would be asked to complete the
case study questions just as they would if this were a class lesson, and this information along
with the instructor’s observations and the film should provide an abundance of useful
information to the instructional designer. Any issues noted at this stage would be corrected prior
to moving on to the field trial evaluation.
6d: Field Trial evaluation plan
Once adjustments are made to the learning activity, based on the input from the SME, the
individual evaluators and the small group participants, I would then conduct a field trial on the
revised lesson plan. The lesson would be conducted in the Medical-Surgical classroom of 24
students by the medical-surgical nursing instructor in Week 14, just as intended once
implemented. I suspect that the dynamics of a large group might change how people interact
while working on their case study because students often take cues from others in the room or
get distracted. Therefore, I would provide separate rooms or lab areas for groups or individuals to
use if they preferred, but in all cases the working areas would be within short distance (less than
50 feet) of the main classroom and the instructor.
Once the lesson was completed and the case study answers submitted for scoring, the
students would be asked to answer an online survey anonymously. In addition, the instructional
designer would interview selected students and the instructor for comments and more in-depth
input than the survey might provide. After gathering that information, additional revisions would
be made to the lesson as needed. Students and the instructor would be asked about the
effectiveness and value of the learning activity as well as how well their prior learning and
experiences prepared them to participate in and learn from this lesson.



Nursing Case Study Project 26

Part 7. Formative Evaluation Report
7a: Evaluation survey
The SME survey is included below and shows the questions asked of the SME, her
responses, and my comments regarding her observations and needed changes. The questions
covered the effectiveness of the lesson, the quality of the materials and her overall evaluation of
the project.
QUESTIONS

REVIEWER COMMENTS RESPONSE

Goals and Objectives
Clear?
Properly written?
Aligned with Bloom’s?
Understandable?
Achievable?
Relevant to the students?
Additional comments?
Objectives are clear statements of
what is specifically expected of the
learner and provides guidelines for
the teacher to measure learner
progress.

Objectives follow the SMART
format: specific, measureable,
achievable, realistic and timely.
The level of cognitive behavior is
aligned with the ability for the
learner to apply prior knowledge of
a patient with diabetes.

Communicate to students what they
are expected to learn and how they
will be evaluated.

Written at appropriate levels of
learning domains and are will easily
be understood by students.

The objectives are well written and
lend themselves to be used in
evaluating higher cognitive skills.
Glad to see the goals and
objectives are well
written, appropriate, and
relevant.
Learning Materials
Adequate and appropriate?
Supportive of the learning
goals and objectives?
Aligned with the goals and
Objectives?
Learning materials are accurate and
up-to-date. Learning materials are
appropriate for characteristics of
the learners and complexity of the
behaviors that are required.

The learning materials are
I was glad to read the
suggestions regarding
using the internet as a
way to get up to date
information and as a way
to reinforce the idea of
evidence based practice.
Nursing Case Study Project 27

Additional comments? supportive and consistent with
meeting the identified goals and
objectives.

Case study is an accurate and
realistic depiction of a patient with
diabetes.

I would suggest encouraging
students to use the Internet for
collection of information. This
would allow the student to obtain
the most up-to-date information.

This would also be a great
opportunity to provide guidance for
evaluating and utilizing reputable
sources.

Excellent development of case
study.

We have just received
approval for Google
ChromeBooks in our
nursing program
classrooms, so we will be
able to implement this
suggestion.
Instructions and Rubric
Clear?
Accurate?
Appropriate for learners?
Provide adequate guidance for
instructors?
Rubric provides guidance for
both content and quality?
Additional comments?
Instructions are clear, accurate, and
appropriate.

Instructions to the student clearly
articulate the instructor’s
expectations for the assignment.

Rubric communicates expectations
about high-quality versus lower-
quality work.

Rubric serves as an appropriate
guideline to structure the feedback
provided by instructor.

Allows for the assessment of
specific student objectives.
I am glad to see that the
instructions and the
rubric are clear, accurate
and appropriate.
Assessments
Adequate opportunity for
formative assessment
provided?
Instructor is allowed adequate
amount of time for formative
assessment throughout student
completion of case study.

I was glad to see that the
SME also thought the
time allotted for the case
study and instructor
comments and
Nursing Case Study Project 28

Summative assessment
measures achievement of goal
and objectives?
Additional comments?
Students have numerous
opportunities to ask questions and
provide input.

Encouraging questions from the
learner is a way to assess student’s
learning and ability to apply the
content.

This will also allow identification
of any difficulties that may arise.

As the instructor works with each
group, adequate time is allocated
for formative evaluation.

Opportunity for students to record
questions prior to experience and
allowing review time at end of the
activity is an ideal strategy for
evaluation to determine the
effectiveness of the instructional
activity.

Summative evaluation appraises the
student learning outcomes and
determines the effectiveness of
instructional strategy.

Through the use of case studies
which promote in-depth thinking
and problem-solving short-answer
questions can be used as a future
testing/evaluation strategy.

assessment of students
was adequate.
Project
Logical and sequential?
Tables and graphs provide
useful information?
Objectives Table easy to use?
ARCS Table easy to use?
Do you have any additional
comments you would like to
Project logical and sequential.

A clear, concise description of the
purposes, objectives, and
competencies are provided.

Case study provides in-depth
analysis and applies didactic
content and theory to a real-life
scenario.
I appreciate the SME’s
comments. It is easy to
assume that the meaning
and intent has been
adequately conveyed to
learners when in fact it
has not. The SME was
helpful in that I felt I
could trust her expertise
and suggestions for
Nursing Case Study Project 29

make about any aspect of this
project?

Table and graphs were easy to use
and illustrated objectives and
assessment.
ARCS Table easy to use and well-
developed.

Project for development of case
study will stimulate critical
thinking, retention and recall.

In a rapidly changing health care
field, critical thinking skills are
especially relevant to students who
will enter a practice profession.

Activity is especially good for the
adult learner by providing peer
interaction and validation of
thinking.

Well-done.
improvements.

7b: Report the results of the expert review
Tamra Carley served as the Subject Matter Expert (SME) for this project. I chose her
because of her knowledge of both nursing and nursing education but also because of her
background in instructional design. I asked Tamra to review the project both from the standpoint
of both the nursing content and the design of the learning activity because if one aspect of the
project was lacking in any way, the entire project would be ineffective for students. By utilizing
the Instructional Design process that is detailed in the Smith and Ragan’s book, Instructional
Design, I was able to construct a comprehensive and apparently effective learning activity. The
SME’s comments confirmed that the process I learned was an appropriate process for this type of
project.
7c: Comments on Change
Tamra did suggest that I consider incorporating computers into this learning activity by
allowing students to use the Internet to search out the most current information, and I completely
agree with this suggestion. While the students do not have access to computers in the classroom
at the moment, we have decided to purchase Google ChromeBooks for the nursing program so
every student will have one available to them in the classroom beginning in the Fall of 2013. Not
only will these be useful for taking notes and so forth, the students can use them for a variety of
projects and activities such as this case study. As the SME points out, this is also a great way to
Nursing Case Study Project 30

give the students guidance about what constitutes a reliable source and gives instructors one
more tool to use when teaching and reinforcing the concept of evidence-based learning.

Part 8. AECT Standards Grid
Standards

Assignments meeting standard in whole or part

Standard 1: DESIGN
1.1 Instructional Systems Design
(ISD) X

ID Project
1.1.1 Analyzing X ID Project; ID Case Analysis
1.1.2 Designing X ID Project
1.1.3 Developing X ID Project
1.1.4 Implementing X ID Project
1.1.5 Evaluating X Selected Discussion Forums; ID Project
1.2 Message Design
1.3 Instructional Strategies X ID Project
1.4 Learner Characteristics X ID Project

Standard 2: DEVELOPMENT
2.0 (includes 2.0.1 to 2.0.8) X ID Project
2.1 Print Technologies X Reading Quiz; ID Project
2.2 Audiovisual Technologies
2.3 Computer-Based Technologies X (all assignments)
2.4 Integrated Technologies

Standard 3: UTILIZATION
3.0 (includes 3.0.1 & 3.0.2)
3.1 Media Utilization X (all assignments)
3.2 Diffusion of Innovations
3.3 Implementation and
Institutionalization
X ID Project
3.4 Policies and Regulations

Standard 4: MANAGEMENT
4.0 (includes 4.0.1 & 4.0.3)
4.1 Project Management
4.2 Resource Management
4.3 Delivery System Management
4.4 Information Management

Standard 5: EVALUATION
Nursing Case Study Project 31

5.1 Problem Analysis X ID Project
5.2 Criterion-Referenced
Measurement X

ID Project
5.3 Formative and Summative
Evaluation X

ID Project
5.4 Long-Range Planning






















Nursing Case Study Project 32

References

Gustafson, K. L., & Branch, R. M. (2002). Survey of instructional development models. (4
th

Ed.).Syracuse, NY: ERIC Clearinghouse on Information and Technology.
Smith, P. L., & Ragan, T. J. (2005). Instructional design. Hoboken, N.J: J. Wiley & Sons.





















Nursing Case Study Project 33

Appendices
Appendix A
Needs Assessment Survey Questions

1. What are the steps, in order, of the nursing process?
2. Why do you assess before you act?
3. Briefly recall what, if anything, you remember about diabetes and its effect on the human
body from the anatomy and physiology classes you took as prerequisites to this program.
4. Describe how elevated blood sugars effect cellular functioning?
5. Explain why elevated blood sugars cause end organ damage.
6. Explain your understanding of the link between diet and diabetes mellitus (DM).
7. Why does DM inhibit wound healing?
8. Have you had any experience caring for patients with diabetes in your previous clinicals?
9. Have you been presented with scenarios in Sims or labs that involved a patient with DM?
10. How would you rate your understanding of nursing care for patients with diabetes?
11. What would you like to know more about regarding diabetes and the care of patients with
diabetes?
12. Have you been assigned a case study in any nursing class previously?
13. What did you find beneficial (or not) about engaging in a case study as a learning activity in
class?
14. Do you have any experience in determining a priority nursing diagnosis for a patient under
your care?
15. What are the essential elements of a properly written nursing diagnosis?
16. Are you familiar with Maslow’s hierarchy of needs as it relates to nursing care?
17. Explain how Maslow’s help you to prioritize the nursing care you provide to patients.
18. Why should nursing interventions be patient specific?




















Nursing Case Study Project 34

Appendix B
Case Study and Answer Sheet

Note: This case study will be provided electronically and can serve as your answer sheet. Simply
type in your answers after each question.
A.B. presents to the ER where you are employed complaining of chronic fatigue,
increased thirst and urination and almost constant hunger. She denies any pain and is not being
treated for any other conditions at this time, and does not have a regular healthcare provider
because she does not have any insurance. A.B. states she decided to come to the ER because she
feels so much worse than normal, plus she does not think she could be seen anywhere else.
Your patient goes on to report that she works as a cashier about 30 hours per week and
stands almost the entire time she is at work, and has noticed over the last few months that her
feet are increasingly painful by the end of the day, almost like she has burning and “pins and
needles,” though she has not been at work today so her feet do not hurt right now. A.B. denies
chest pain, shortness of breath, or weakness or headaches, but does state again just how tired she
feels all the time and how hungry she is as well. She goes on to tell you that she thinks she has
gained 30 pounds or more this year due to the combination of lack of exercise due to her fatigue
and her constant hunger. A.B. sounds frustrated when she states that she just cannot seem to get a
handle on either problem and has begun to think she may really have a problem.
After gathering more of the patient’s history you move on to the physical assessment. Her
vitals as are follows: BP 160/94, HR 82, R 24, T 99.6. As you are speaking to her you notice that
her breath is rather fruity smelling and overall her color does not look good.
1. Given your thoughts at this time, what labs can you anticipate the provider ordering on this
patient?
2. Are there any other nursing actions you should take right now, even before she is seen by a
provider?
3. Did you check the patient’s blood sugar? Why is this action important and how does it relate
to the care of this specific patient? (Your instructor will provide you with the patient’s BS.)

The provider arrives and does a quick assessment of the patient and orders labs as you
anticipated, and asks that they be done STAT. Your patient asks for a glass of water while she
waits for the results.
4. Do you give it to her? Why or why not?
The lab results come back as follows:
Get the labs from your instructor after you have completed questions 1-4.
5. Which of the recent labs are relevant? Why?
6. How do the labs drive the care for this patient?
7. Are any of the lab values critical?
8. What should you do next and how soon?
9. What do those lab values mean, anyway? Why are they relevant in this case?
10. How might this new information change your nursing care?
Nursing Case Study Project 35


You now have a little bit better idea of what is going on with this patient and what you can
anticipate in terms of treatments.
11. What medical diagnosis do you suspect?
12. Given your patients current condition you begin to formulate your current, working nursing
diagnosis. You recognize that this may change as new information comes in, but what is your
priority nursing diagnosis right now, written in complete and proper form?
13. Using Maslow’s, explain why you chose the priority nursing diagnosis you did.
14. Give three patient-specific nursing interventions relevant to your priority nursing diagnosis,
with rationales and expected outcomes. Remember to make certain that your nursing
interventions are:
a. Patient specific
b. Relate to the nursing diagnosis
c. Are something you can do
d. Can be done by you while the patient is under your care
e. Can be evaluated by you in the time the patient is under your care.

You recognize that the patient may be admitted, but you decide to go ahead and begin providing
nursing care to this patient on the assumption that you will be her nurse for the next few hours.
15. Why is this or is this not the correct thing to do?

The ER provider returns, states his medical diagnosis and admits the patient. What was the
medical diagnosis and were you correct when you made your best guess earlier? What do you
think confirmed it for the provider? Think about it, and then go confirm your answer with your
instructor.
Bonus points!!
For 5 extra points on this assignment answer the following questions:
16. What should you do next?
17. Why? Give the three most important reasons you can think of.







Nursing Case Study Project 36

Appendix C
Case Study and Answer Guide

A.B. presents to the ER where you are employed complaining of chronic fatigue,
increased thirst and urination and almost constant hunger. She denies any pain and is not being
treated for any other conditions at this time, and does not have a regular healthcare provider
because she does not have any insurance. A.B. states she decided to come to the ER because she
feels so much worse than normal, plus she does not think she could be seen anywhere else.
Your patient goes on to report that she works as a cashier about 30 hours per week and
stands almost the entire time she is at work, and has noticed over the last few months that her
feet are increasingly painful by the end of the day, almost like she has burning and “pins and
needles,” though she has not been at work today so her feet do not hurt right now. A.B. denies
chest pain, shortness of breath, or weakness or headaches, but does state again just how tired she
feels all the time and how hungry she is as well. She goes on to tell you that she thinks she has
gained 30 pounds or more this year due to the combination of lack of exercise due to her fatigue
and her constant hunger. A.B. sounds frustrated when she states that she just cannot seem to get a
handle on either problem and has begun to think she may really have a problem.
After gathering more of the patient’s history you move on to the physical assessment. Her
vitals as are follows: BP 160/94, HR 82, R 24, T 99.6. As you are speaking to her you notice that
her breath is rather fruity smelling and overall her color does not look good.
1. Given your thoughts at this time, which labs or other diagnostics can you
anticipate the provider ordering on this patient? CBC, A1c, CMP (sodium,
potassium), BUN and creatinine, serum glucose, ketones, ABGs, bicarbonate, pH.
2. Are there any other nursing actions you should take right now, even before she is
seen by a provider? Blood sugar check with a glucometer.
3. Did you check the patient’s blood sugar? Why is this action important and how
does it relate to the care of this specific patient? (Your instructor will provide you
with the patient’s BS.) Student must provide a brief but accurate explanation of
why checking this patient’s BS with a glucometer now is good nursing practice.
(Baseline, serial BS, monitor status, provide relevant information to provider)

The provider arrives and does a quick assessment of the patient and orders labs as you
anticipated, and asks that they be done STAT. Your patient asks for a glass of water while she
waits for the results.
4. Do you give it to her? Why or why not? Has the provider made the patient NPO?
Is there a standard protocol for all ER patients? Will providing the patient with
water to drink impact her labs? Student needs to provide reasoning and answer
based on Maslow’s and standards of nursing care.

The lab results come back as follows:
Serum Glucose - 250mg/dL
Potassium – 6.5 mEq/L *critical
BUN - 43
Nursing Case Study Project 37

Creatinine – 2mg/dL
HCT – 56%
Sodium – 160 mEq/L * critical
Serum Ketones - Positive
pH 7.1
Bicarbonate - 13mEq/L
Anion gap - >12
A1c – 9.3
Albumin – 4.8 g/dL
Serum total protein – 7.3 g/dL
Chloride – 110 mEq/L
ALP – 90 units/L
ALT – 31 IU/L
AST – 33 IU/L
Total Bilirubin – 0.7 mg/dL
Which of the recent labs are immediately relevant? Why?
Serum Glucose - 250mg/dL
Potassium – 6.5 mEq/L *critical
HCT – 56%
Sodium – 160 mEq/L * critical
Serum Ketones - Positive
pH - 7.1
Bicarbonate - 13mEq/L
Anion gap - >12
All indicate dehydration and/or DK.
How do the labs drive the care for this patient?
Medical emergency, patient will be admitted to ICU or IMC.

5. Are any of the lab values critical?
Sodium and potassium.
6. What should you do next and how soon?
Report to RN so s/he can notify provider within 30 minutes. Provide vitals and LOC
Document that you reported.
Follow up and make certain the values were reported. Document that.
Monitor RR and LOC.
Notify RN of any changes in patient condition.
7. What do those lab values mean, anyway? Why are they relevant in this case?
Potassium – hypokalemia is common in DK so monitoring cardiac and muscular function
(can impact breathing). May notice malaise, palpitations, muscle weakness,
hyperventilation to compensate for acidosis.
Sodium – Lethargy, irritability, weakness, edema can occur with hypernatremia, can
progress to seizures and coma. Must immediately report any change in LOC.
HCT – not an immediate concern medially, but an indication of dehydration
Bicarbonate, ion gap and pH all indicate acidosis, so student should mention this and give
a brief explanation of the lab values.
Nursing Case Study Project 38

8. How might this new information change your nursing care? Medical emergency,
vigilance, constant care, ECG, vitals, muscle tone, LOC all must be monitored,
prepare to transfer patient to higher level of care such as ICU or IMC. Notify RN
of any changes in condition.

You now have a little bit better idea of what is going on with this patient and what you can
anticipate in terms of treatments.
9. What medical diagnosis do you suspect? DK
10. Given your patients current condition you begin to formulate your current,
working nursing diagnosis. You recognize that this may change as new
information comes in, but what is your priority nursing diagnosis right now,
written in complete and proper form? Students may come up with a number of
priority nursing diagnoses here so rather than state that we have only one we are
looking for, consider whatever the student presents and look at the rationale. If
they have utilized the ABCs and Maslow’s they should arrive at a reasonable
conclusion. If not, help direct them to the point at which their thought process was
derailed and guide them to the priority considerations and allow them to work
through the problem again. They should be considering the critical lab values
such as the potassium and would be concerned with the results of hypokalemia,
for example, or they may be concerned with the patient’s dehydration. Since in
the real world we would not limit ourselves to just one nursing diagnosis, multiple
priority nursing diagnoses may be acceptable here as long as the student can
support their choice.
11. Using Maslow’s, explain why you chose the priority nursing diagnosis you did.
Is the student’s rationale sound and supported?
12. Give three patient-specific nursing interventions relevant to your priority nursing
diagnosis, with rationales and expected outcomes. Remember to make certain that
your nursing interventions are:
a. Patient specific – not textbook or typical, have they made a reasonable
effort to speak to this patient’s situation rather than the average patient?
b. Relate to the nursing diagnosis. Interventions must relate to the nursing
diagnosis or they are wrong and must be rewritten.
c. Interventions are something you can do. Nurse does not rely on others for
patient care.
d. The intervention can be completed by you while the patient is under your
care. Intervention can be completed while the patient is under the nurse’s
care rather than at some point in the future.
e. Can be evaluated by you in the time the patient is under your care. Can the
student be reasonably sure that they will have the patient long enough to
evaluate their intervention?

You recognize that the patient may be admitted, but you decide to go ahead and begin providing
nursing care to this patient on the assumption that you will be her nurse for the next few hours.
Nursing Case Study Project 39

13. Why is this or is this not the correct thing to do? The student needs to recognize
that this patient has a medical emergency and needs care now regardless of where
she may be treated or by whom in the future.

The ER provider returns, states his medical diagnosis (diabetic ketoacidosis) and admits the
patient. Were you correct when you made your best guess earlier? What do you think confirmed
it for the provider? Think about it, and then go confirm your answer with your instructor.
Bonus points!!
For 5 extra points on this assignment answer the following questions:
14. What should you do next? Chart or document.
15. Why? Give the three most important reasons you can think of.
a. Continuity of care – others will know what was done already
b. If you do not document it, it did not happen
c. Legal document, protects you, patient, others in court
d. Proper and complete billing
e. Patient protection – complete medication and health information helps
provide for patient safety.
f. Proves you addressed problems and that you followed up on your
interventions

























Nursing Case Study Project 40

Appendix D
Diabetes Case Study Rubric

Points 
Question 
5
Excellent
3
Average
0
Does not Meet
Expectations
1. ID 5
necessary
labs.
Student
Learning
Objective
(SLO) #1
Correctly identifies 5 or
more labs needed to
accurately assess the
diabetic patient. (A1c,
Blood Glucose,
Correctly identifies 3-4
labs needed to accurately
assess the diabetic patient.
Correctly identifies
fewer than 3 labs
needed to accurately
assess the diabetic
patient.
2. Nursing
Actions
SLO # 4
Lists 3 or more priority
nursing
actions/interventions based
on Maslow’s.
Lists 2 priority nursing
actions/interventions based
on Maslow’s.
Lists fewer than 2
priority nursing
actions/interventions
based on Maslow’s.
3. Blood sugar
checks and
glucometer.
SLO #2
Gives a detailed, accurate,
patient-specific explanation
of how BS checks and the
glucometer are used in
patient care.
Gives a detailed, accurate,
non-patient-specific
(general patient care or
textbook) explanation of
how BS checks and the
glucometer are used in
patient care.
Fails to give
adequate details or
provides inaccurate
information AND
fails to provide
patient-specific
explanation of how
BS checks and the
glucometer are used
in patient care.
4. Do you give
her water?
SLO #4
Provides a well thought out
rationale for the decision
and cites Maslow’s and
standard nursing care to
support the decision.
Provides a rationale for the
decision that is lacking in
detail and cites standard
nursing care to support the
decision.
Provides rationale
that is lacking in
specificity and
support.
5. Able to
identify
relevant labs?
SLO #1.2
IDs all relevant labs, states
why they are important to
this patient.
IDs 5 or more relevant
labs, but fails to give clear
explanations about the
importance of each.
IDs fewer than 5
relevant labs, or
fails to state why
they are important
to this patient.
6. How do labs
drive patient
care?
SLO #1.2
Provides logical explanation
for how labs will drive care
for this specific patient.
Provides incomplete
explanation for how labs
will drive care for this
specific patient, or answer
is not patient specific.
Fails to provide an
explanation for how
labs will drive care
for this specific
patient.
7. ID critical
lab values.
SLO # 3
Able to identify 2 critical
lab values.
Able to identify 1 critical
lab value.
Unable to identify
any critical lab
values.
8. Understands Clearly states 3 nursing Clearly states 2 nursing States 1 or fewer
Nursing Case Study Project 41

how to
handle
critical lab
values.
SLO # 3.2
duties related to critical lab
values. (To whom reported,
in what time frame, and
what does the nurse do
next?)
duties related to critical lab
values. (To whom reported,
in what time frame, and
what does the nurse do
next?)
nursing duties
related to critical lab
values.

9. What do
critical labs
mean and
why are they
relevant?
SLO #3.1
Gives clear, complete,
logical, patient-centered
explanation regarding the
meaning and relevance of
the critical lab values.
Gives explanation
regarding the meaning and
relevance of the critical lab
values but the explanation
lacks details, logic, or is
not patient-centered.
Explanation
regarding the
meaning and
relevance of the
critical lab values is
absent or lacks
sufficient details as
to be illogical, or is
a textbook answer
that applies to all
patients generally
but does not address
this patient’s
situation.
10. Anticipate
changes in
nursing care
based on
critical lab
values.
SLO #3.1.1
Provides a logical,
complete, patient-centered
explanation of anticipated
changes in nursing care
relative to critical lab
values.
Provides an adequate, but
incomplete, patient-
centered explanation of
anticipated changes in
nursing care relative to
critical lab values.
Fails to provides a
an explanation of
anticipated changes
in nursing care
relative to critical
lab values, or the
explanation lacks
sufficient details as
to be illogical, or
remarkably
incomplete.
11. Not graded.
12. Priority
nursing
diagnosis.
SLO #4
SLO #4.1
Provides accurate,
complete, properly written
priority nursing diagnosis
based on Maslow’s.
Provides accurate, priority
nursing diagnosis based on
Maslow’s, but the nursing
diagnosis is missing 1
required element.
Provides and
inaccurate nursing
diagnosis, or the ND
is accurate but is
incomplete and
missing multiple
required elements.
13. Reasoning
behind your
priority
nursing
diagnosis.
SLO #4
SLO #4.1
Provides a logical, patient-
specific explanation of why
priority nursing diagnosis
was chosen, and shows how
Maslow’s was applied in
this case.
Provides an adequate,
patient-specific explanation
of why priority nursing
diagnosis that lacks details
or logic, or is unclear about
how Maslow’s was applied
in this case.
Provides no patient-
specific explanation
of why priority
nursing diagnosis
was chosen or fails
to address how
Maslow’s was
applied in this case.
Nursing Case Study Project 42

14. Nursing
interventions.
SLO# 6
SLO # 6.1
Provides 3 nursing
interventions that are:
a. Patient
specific
b. Relate to the
nursing
diagnosis
c. Are
something
you can do
d. Can be done
by you while
the patient is
under your
care
e. Can be
evaluated by
you in the
time the
patient is
under your
care.
Provides 2 nursing
interventions that meet all
requirements (a-e) or
provides 3 nursing
interventions but 1-3 total
elements (a-e) across all
three interventions are
missing or inappropriate.
Provides fewer than
2 nursing
interventions that
meet all
requirements (a-e)
or provides 3
nursing
interventions but 4
or more total
elements (a-e)
across all three
interventions are
missing or
inappropriate.
15. Patient is
admitted.
SLO #3.1.1
SLO #4
SLO #1.2
Provides a logical and
complete analysis of
whether or not this patient
should be admitted to the
hospital, and the
explanation considers 3
critical aspects of patient
care as indicated in the
SLOs listed under item 15.
Provides an adequate
analysis of whether or not
this patient should be
admitted to the hospital, or
the explanation properly
considers only 2 critical
aspects of patient care as
indicated in the SLOs
listed under item 15.
Fails to attempt an
answer.
16. Now that the
patient has
been
transferred
out, what do
you do?
Gives the proper response. Not applicable. Fails to respond or
the response is
incorrect.
17. Give three
reasons for
your answer
in item 16.
Lists three priority reasons
behind your response to
item 16.
Lists 2 priority reasons
behind your response to
item 16.
Lists fewer than 2
reasons.

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