Monday, October 14, 2013
Blog # 3:Designing Problem Based Writing Assignments
Hello WID Faculty: for your third blog please read Bean Chapter 6, Formal Writing Assignments, where he focuses on how to create "problem-based assignments to promote critical thinking and active engagement with course subject matter" (89). This chapter is rich in suggestions on how to vary assignment design (p. 92), how to start with micro-themes (pp. 112-113) and how to design "meaning constructing" tasks by giving students a RAFT (role, audience, format, task) and a TIP (task as intriguing problem) (pp. 98-99). Take time to browse through this chapter and then begin by designing a micro-theme that fits the material of your course (like the Dear Dr. Science one on p 112). Share that assignment on the blog, try it out in class and return to blog to share how it went. We will move to a more formal assignment (still encouraging critical thinking) in our next blog.
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According to Robert Wood Johnson Foundation (2012) medication errors can compound a medical crisis which can have tragic results. In the U.S medication errors contribute to more than 7.000 inpatient deaths per year.
ReplyDelete1. In the ER/ICU or any hospital settings a nurse is faced with many difficult situations and critical thinking is important.
In a small town upstate New York two nurses worked the night shift on a medical unit and often had patients who were in the process of dying. Many of these patients suffered a great deal of pain. The two nurses had spoken frequently to the local doctor who admitted patients to the hospital, asking for more liberal orders for pain medication. The physician continually denied increasing medication doses or frequency of medication administration. The two nurses spoke with the Director of Nursing and the Medical Director, both of whom told the nurses there was nothing they could do, and to do the best they could. The two nurses then made an agreement with each other to begin a stockpile of narcotics so they could relieve their patient’s pain. Any medication from a syringe that would have been wasted was injected into a vial, and each nurse signed off the waste for each other.
• What is the ethical dilemma faced by these two nurses?
• What legal issues are involved?
• What would you have done if these were your patients?
• Was the code of nursing ethics violated? Do nurses have the right to relieve patients from pain without an order?
• Is ever acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?
• Would you ever undertreat a patient’s pain for fear of the patient becoming addicted to the medication?
• I showed them the video below:
http://www.youtube.com/watch?v=EsvxAFvSgTI
Nurses are faced with ethical dilemmas more often than it seems nowadays. At times it takes a collaborative effort and critical thinking is important. Based on the video clip on “Ethics” write a mini essay (one-two paragraph) on the principles of ethics that may have been breached. What would you do in this situation and why?
This was one of my personal stories that I shared with the students and we discussed it in class in groups.
While I was working in the ICU settings I remembered taking care of an individual who had AIDS. I remembered seeing many of his family, friends and his girlfriend visiting him frequently.
This individual was in his mid-forties and his girlfriend was a young woman who was in her mid-twenties.
One particular day the young lady came to me and asked “Nurse can you tell me what’s wrong with my boyfriend? Does he have cancer or pneumonia, is he going to die… because he is not telling me anything?”
At this moment I thought there is this one man who might be responsible for many lives…. What do I do? Do I breach patient confidentiality if I know that he/she is harming others? What would you do as a nurse and why? Is this murder?
Hi Faith,
DeleteThanks for sharing this assignment! If possible, would you mind sharing a brief reflection on how it went/whether you were happy with student responses? It might even be good to share a few sample student responses, so that we could give better feedback on refining it with a view to making you get the sort of work you are looking for from students.
These all sound like compelling dilemmas that challenge students to think critically about nursing and ethics. For the first assignment (#1), do you tell students what form you would like the essay to take (i.e. length, should it have a formal essay structure)? As written, I would imagine that many students probably devote a paragraph to each of the questions listed. If you are hoping that they formulate the essay as a coherent whole, it might help students if they had a sense of structure. One possibility might be to ask them to begin by outlining the ethical and legal issues, proceed to make an evaluation about the applicability of those issues to the case, and then conclude with more general concerns about what the student would do in such a case.
Because they are addressing so many different questions within one essay, it might also be helpful to "scaffold" the assignment. You could take any number of the questions on its own as a low-stakes assignment. Particularly if any of the questions will require sources to answer, it might be helpful to stage these as individual steps.
For any of these, I think it also might be helpful to set up the rhetorical situation for the student. Are they writing for their classmates? To convince a lay audience? To other medical professionals? A shift in audience might change the tone and direction of the responses, and help them think different, if that seems productive.
- Meredith
Meredith--I like your suggestion about scaffolding (putting assignment in stages) by having them do low stakes writing about each issue before combining. Also love the idea of giving students an audience--it can make the writing more authentic and make students feel they are contributing to professional conversation.
DeleteThanks for posting this Faith. I watched the video--wow--this clip from ER shows how much is at stake with a decision! Look forward to hearing how your students respond and how you discuss it in class. Meredith Benjamin, one of our Writing Fellows, will also be responding to your posts with questions and suggestions. See you Wednesday.
ReplyDeleteThe assignment will provide the opportunity for students to critically think of how the material that is learned in the classroom/lecture impact their lives and those that they will be assisting upon graduation. There are numerous legal issues in nursing one of them includes personal responsibility and accountability for your actions as a prudent nurse as defined in the nurse practice act.
ReplyDeleteLearning concept for the week Ethical and Legal Aspects of Nursing.
After each group has presented as a class we will discuss how all the topics relate.
Microtheme assignments:
Group 1. You have been working since 6:30 this morning, and you have a full patient load. Your nursing team is minus a CNA and the RN has been working since 10:30 the night before. It is now 2:00 pm and the nursing supervisor has come to tell you that the LPN scheduled for the evening shift called in sick, and there is no one else to replace him. You are told that you will have to do mandatory overtime to cover the shift. This would mean you would be working 16 hours. You would then be required to come back in the morning for your next shift starting at 6:30.
• Discuss how mandatory overtime can affect patient care?
• What are the effects of mandatory overtime on the nurses?
• What is the mandatory overtime law in New York State?
Group 2. Write a short paper describing what your concept of a human being is.
Group 3. You are a 23-year-old LPN/LVN graduate performing in-take psychiatric assessment for a juvenile crisis center. Today, Helen, a 17-year-old girl comes to your unit after a suicide attempt. She will be in a 48-hour hold.
There is an immediate attraction between the two of you. She discharges herself after 48 hours. Other than performing the intake assessment, you never provided any direct client care for her. One month later, you decide to call her, under the guise of a follow-up call, which is not in your job description/duties.
Since you never provided any client care, you decide to ask her out on a date. You begin dating and your activities included, but were not limited to, drinking alcohol, smoking marijuana, and engaging in intimate sexual activities.
After 6 months, you begin to tire of your relationship and you end it. Three months later, you receive a registered letter from your state board of nursing ordering you to appear at a disciplinary hearing. As a result of this hearing, your nursing license is suspended for 2 years. The board also notified your employer, who terminated you. During the 2-year suspension, you have been mandated to participate in a chemical dependency program, to take a remediation course in client confidentiality, and to adhere to the privacy stipulations set forth in HIPPA. After completion of these activities and completing the 2-year suspension, you can petition the board of nursing to restore your licensure.
1. What laws did this nurse break?
2. Were these crimes civil or criminal?
3. What regulations of your state board nurse practice act were violated?
4. Is dating a client unethical or illegal?
5. Should this person get his license back when he petitions the board for restoration?
Classroom assisted videos:
http://www.youtube.com/watch?v=6rRlUcjA88s
http://www.youtube.com/watch?v=Td3_mJs9mtY
Thanks Dr. Van!
DeleteMy students loved this movie clip! They were silent and I saw the concern in some of their eyes. But this is reality and nursing involves ‘Lives’ so I want them to understand the depth of what nursing entails.
I wanted them to see the ethical dilemmas that nurses are faced with and how one decision can make a difference!
Nursing involves proper communication, documentaion and critical thinking skills… It’s not just ‘task-oriented’ but I want them to see the impact one false move can make!
The students really enjoyed it and we had an awesome discussion!
It was so nice meeting you!
Faith
Hey Roxanne,
DeleteThanks for your post. This microtheme assignment on the ethical and legal aspects of nursing seems like a really important assignment for your students.
I really enjoy the prompt for group 2. I bet you get all sorts of great responses to that! :) Since this prompt is the shortest of the three, and doesn't contain any corresponding questions, do you find that the students have much difficulty responding to it? Or at least, responding to it in the way that you would like them to (maybe within an ethical and legal framework or specifically dealing with nursing)?
I especially like group 3’s prompt: the situation is laid out nicely and the questions directly correspond to the situation, making it seem a bit easier for the students to know how to approach and respond to the assignment (I know that if I was a student, I would appreciate the clarity of this prompt’s lay out and question format).
How do you grade the students on this assignment? How have the results been for each group prompt?
Hi Roxanne--I'm interested in Antoinette's questions about how much they answer and whether they delve into the ethical issues--such interesting material! Also about grading I posted a note reminding everyone about Bean's rubrics--maybe it would be good to share some rubrics we each use?
DeleteWe recently went over bioethics in the health care setting. We talked about performing research on animals and humans to gain better knowledge of new techniques and medicines to help develop vaccines and possible cures. I asked them to consider the following scenario:
ReplyDeleteYou are a research scientist who is 99% sure that you have found a vaccine for HIV/AIDS. How would you go about approaching the IRB to allow you to perform experiments with it? Would you feel comfortable with possibly exposing humans to the disease and the vaccine failing? Please write a persuasive essay to the IRB to explain what you are trying to accomplish so that they may consider your research project.
I had them write a one page essay on the topic.
Hi James:
DeleteWow! I love your scenario! You gave me an idea for my future classes!
I can't wait to hear how your students addressed this issue. It had me thinking as well and reminded me of the 'Tuskegee Experiment" only this time subjects are aware...
Thanks for your input!
Faith
James--would love to see what students did with this assignment and am wondering if the results suggested that this is an assignment that needs to be broken down into parts because all sorts of questions come to mind: who should be the subject of the vaccine and why? should animals be used first? If I were a student I would want to see a model of a well executed experiment proposal--how it is constructed? In other words this feels like an important assignment that could be staged or scaffolded more precisely. What were the papers like?
DeleteThis sounds similar to the Heinz Dilemma (steal medication that you cannot afford to save your wife's life).....individual benefits over the setting an example for society.
ReplyDeleteThis is a great approach to getting your students thinking critically, as well introducing them to the IRB. It took my students a while to fully understand the neutral role that the IRB is supposed to serve and what exactly the function of the IRB should be.
Thanks for your post.
Hi Brett:
DeleteYou are right! It is similar to the Heinz Dilemma: Stealing the medication to save his wife. When is stealing right? Stealing a life or a drug?
The students got so involved and I wanted them to think critically and to look beyond what they see!
You’re correct about introducing them to the IRB which can be challenging for some students. I appreciate your suggestion.
Thanks for your input.
Faith
Hey Faith,
ReplyDeleteThe assignment went well.....about 60% of the class said that they would not go forward with the research due to the risks involved. 40% said that they would try everything possible to get it approved. I think it would be even better to pose the question - would they be willing as the researchers to participate in the study and become subjects themselves??? I bet close to 100% would say no!!
Oh Wow! Thanks James for keeping me posted. I will definitely use this for my next class.
ReplyDelete