Nursing Discussion Case Study

Purpose

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.

Case Study & Discussion Questions

John is a 46-year-old male who presents for his yearly physical examination. He has no complaints. Previous medical history is notable for obesity and hyperlipidemia. He reports a very sedentary lifestyle. He sits at a desk for 8 to 10 hours per day and when he comes home he “just wants to relax in front of the television.” He doesn’t feel motivated enough to exercise on a regular basis, although he knows he should.

John is allergic to penicillin (hives). Medications include atorvastatin 10mg daily and a multivitamin. He occasionally takes acetaminophen for a headache.

Family history is significant for diabetes (mother, maternal grandmother, paternal grandfather) and hypertension (father and brother). He is a nonsmoker and reports drinking “a few beers on the weekend during football season”. His diet largely consists of fast food meals. He drinks sweet tea with every meal and an additional 3-4 cups of coffee per day. Previous labs and exam last year are unremarkable.

Vitals today: BP 130/70 mm Hg, pulse 82 and regular, temperature 98.7, respirations 18, height 6’1”, weight 235 pounds (up 3 lbs. since his visit 1 year ago). He completed fasting labs prior to this appointment as he was instructed which reveal the following:

Fasting plasma glucose=209 mg/dl, HgbA1C=9.1%, TSH=4.0mU/L and Free T4=1.1 ng/dl. Fasting lipid panel includes the following: total cholesterol=190 mg/dL, HDL=35 mg/dL, LDL=120 mg/dL and triglycerides=260 mg/dL.

Physical exam is remarkable for obesity but is otherwise normal.

· What are your treatment goals for John?

· What is your pharmacologic plan and rationale? (cite with appropriate clinical practice guidelines or scholarly, peer-reviewed journals)

· What is the mechanism of action for each drug?

· Please give five medication teaching points for each drug prescribed.

· How would you change the plan if his initial HbgA1C was 14.0 mg/dL and his fasting blood glucose was 350mg/dL along with a urine dipstick that revealed 3+ glucose and + ketones? Provide a detailed alternative plan with the rationale.

Discussion Guiding Principles

The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of discussions provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the discussion generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. Discussions foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.

Direct Quotes

Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

DISCUSSION CONTENT
Category Points % Description
Application of Course Knowledge 35 35% 1. Decisions are well supported with evidence based medicine (EBM) arguments that are in-line with the scenario; AND

2. Proper rationale and reasoning skills are demonstrated; AND

3. Information is taken from source(s) with appropriate interpretation/evaluation to develop a comprehensive analysis or synthesis of the topic at hand; AND

4. Applies concepts to personal experience in the professional setting and/or information has relevant application to real life; AND

5. All of the post makes direct reference to concepts discussed in the lesson; AND

6. Posts are on topic and answer all presented questions which demonstrates a solid understanding of the topic.

(6 critical elements)

Support from Evidence-Based Practice (EBP) 35 35% 1. Discussion post is supported with appropriate, scholarly sources; uses valid, relevant, and reliable outside sources to contribute to the threaded discussion; AND

2. Sources are published within the last 5 years (unless it is the most current CPG); AND

3. Reference list is provided and in-text citations match; AND

4. Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions

(4 critical elements)

Interactive Dialogue 15 15% 1. Student provides a substantive* response to at least one topic-related post of a peer; AND

2. Evidence from appropriate scholarly sources are included; AND

3. Reference list is provided and in-text citations match; AND

4. Student responds to all direct faculty questions OR if student was not asked a direct question student responds to either a 2nd peer post or a faculty question directed towards another student

(*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response

(4 critical elements)

      Total CONTENT Points= 85 pts
DISCUSSION FORMAT
Category Points % Description
Grammar, Syntax, Spelling & Punctuation 15 15% Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*

(*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.

 

      Total FORMAT Points= 15 pts
      DISCUSSION TOTAL= 100 pts

 

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeApplication of Course Knowledge

Decisions are well supported with EBM arguments that are in-line with the scenario; AND  Proper rationale and reasoning skills are demonstrated; AND  Information is taken from source(s) with appropriate interpretation/evaluation to develop a comprehensive analysis or synthesis of the topic at hand; AND  Applies concepts to personal experience in the professional setting and/or information has relevant application to real life; AND  All of the post makes direct reference to concepts discussed in the lesson; AND  Posts are on topic and answer all presented questions which demonstrate a solid understanding of the topic.  (6 critical elements)

35.0 pts

Excellent

All 6 critical elements are present.

32.0 pts

V. Good

5 elements are present.

29.0 pts

Satisfactory

3-4 elements are present.

18.0 pts

Needs Improvement

1-2 elements are present.

0.0 pts

Unsatisfactory

0 elements are present.

35.0 pts
This criterion is linked to a Learning OutcomeSupport from Evidence-Based Practice (EBP)

Discussion post is supported with appropriate, scholarly sources; AND   Sources are published within the last 5 years (unless it is the most current CPG); AND  Reference list is provided and in-text citations match; AND  Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions  (4 critical elements)

35.0 pts

Excellent

All 4 critical elements are present.

32.0 pts

V. Good

3 critical elements are present.

29.0 pts

Satisfactory

2 critical elements are present.

18.0 pts

Needs Improvement

1 critical element is present.

0.0 pts

Unsatisfactory

0 critical elements are present. *Students should note that factitious sources, sources that are clearly not read by the student and used, or sources that have incorrect dates will result in an automatic ZERO (0) for this section for the week.

35.0 pts
This criterion is linked to a Learning OutcomeInteractive Dialogue

Student provides a substantive* response to at least one topic-related post of a peer; AND  Evidence from appropriate scholarly sources are included; AND  Reference list is provided and in-text citations match; AND  Student responds to all direct faculty questions OR if student was not asked a direct question student responds to either a 2nd peer post or a faculty question directed towards another student  (*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response  (4 critical elements)

15.0 pts

Excellent

All 4 critical elements are present.

13.0 pts

V. Good

3 critical elements are present.

12.0 pts

Satisfactory

2 critical elements are present.

7.0 pts

Needs Improvement

1 critical element is present.

0.0 pts

Unsatisfactory

0 critical elements are present.

15.0 pts
This criterion is linked to a Learning OutcomeGrammar, Syntax, APA format

Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*  (*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included

15.0 pts

Excellent

0-1 errors in grammar, syntax, spelling, punctuation, or APA format*

13.0 pts

V. Good

2-3 errors in grammar, syntax, spelling, punctuation, or APA format*

12.0 pts

Satisfactory

4-5 errors in grammar, syntax, spelling, punctuation, or APA format*

7.0 pts

Needs Improvement

6-9 errors in grammar, syntax, spelling, punctuation, or APA format*

0.0 pts

Unsatisfactory

10 or more errors in grammar, syntax, spelling, punctuation, or APA format*

15.0 pts
This criterion is linked to a Learning OutcomeDiscussion late penalty deductions

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0)

0.0 pts

Manual Deductions

0.0 pts

Manual Deductions

0.0 pts
This criterion is linked to a Learning OutcomeTotal Participation Responses

A 10% penalty will be imposed for not entering the minimum number of interactive dialogue posts (3) OR not posting on the minimum required number of days (3). NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0)

0.0 pts

Manual Deductions

0.0 pts

Manual Deductions

0.0 pts