Available online 1 November 2022

Abstract

Nursing students often find pathophysiology challenging and articles examining effective teaching-learning strategies to address these challenges are limited. The objective of this study was to develop, implement, and evaluate the effectiveness of a new model for teaching pathophysiology in nursing education. A quasi-experimental study guided by Analyze, Design, Develop, Implement, and Evaluate (ADDIE) Model and Bloom's Taxonomy was used to develop and implement the Combine, Question, Apply (CQA) Model for three academic years to 190 nursing students enrolled in pathophysiology courses. Surveys, descriptive frequencies, independent t-tests, and qualitative measures were completed. Course and small group activities were highly rated. Student grades statistically had a gradual improvement following the CQA Model implementation (p = <.001). Following the CQA Model implementation, student performance improved. Students valued the online recorded videos and small group activities. This CQA Model may be applicable in other nursing and related professional courses.

Section snippetsBackground

Pathophysiology is an intensive course that combines biology, chemistry, anatomy, and physiology content to give nursing students an understanding of disease processes. The American Association of Colleges of Nursing (AACN) (2021) Essential four spheres of care include disease prevention/promotion of health and well-being and chronic disease care, which includes management and prevention of negative outcomes. The AACN (2021) states that a core competency for an entry level nurse is to “apply or

Phase I: Analysis of the Previous Model

First, we reviewed our undergraduate pathophysiology course outcomes. The previous model consisted of three hours of face-to-face lecture with 70–90 students once a week followed by three hours of small group activities with 20–30 students later in the week. The face-to-face lecture generally consisted of lectures delivered via PowerPoint presentations on various pathophysiology topics. Small group activities involved individual assignments related to weekly lecture content.

The review of the

Phase II: Analysis of Theories Used in the CQA Model Design

Before the development of the CQA Model, an analysis of Bloom's taxonomy, an evaluation of the feasibility of proposed course structure changes, including scheduling considerations, and an assessment of the current technology and resource support were completed. This CQA Model strategically combines teaching-learning strategies to enhance student learner engagement, clinical judgment, and application of pathophysiology knowledge in professional nursing practice.

Methods

A quasi-experimental study using Analyze, Design, Develop, Implement, and Evaluate (ADDIE) Model (Branson et al., 1975) and Bloom's Taxonomy (Bloom et al., 1956; Morton & Colbert‐Getz, 2017) using both qualitative and quantitative methods.

Participants

The participants, selected with a convenience sample method, consisted of nursing students who met inclusion criteria of being enrolled in the junior-level undergraduate pathophysiology and applied pathophysiology courses during one of the three academic years, 2016–2019. Each pathophysiology course was 4 credit hours, totaling eight credits a year.

This study took place at a Baccalaureate nursing program in the upper Midwestern United States. This study was approved by the University

Student Preparation

Based on the review of Bloom's Taxonomy, structural course changes, and design of the CQA Model, we created the student pre-class content to focus on the bottom two of Bloom's cognitive tasks: remembering and understanding. Pre-class consisted of one hour of online work. Students watched online recorded lectures and completed online learning activities associated with the textbook. Online recorded lectures consisted of 3-4 short videos detailing the weekly concept and exemplars (specific

Objective and Research Questions

The objective of this study was twofold. First, this study aimed to develop and implement a new model for teaching pathophysiology in nursing education. Second, this study aimed to evaluate the effects of the newly developed CQA Model on student outcomes and evaluations. Specific research questions included:

1.

How do students rate strategies and activities implemented in the CQA Model?

2.

How do students perform based on course and exam scores in the CQA Model?

3.

What is the difference in grades between

Outcomes

Our primary outcome was development of the CQA Model. Secondary outcomes were improved course evaluation, exam grades, and student satisfaction rates.

Statistical Methods

To investigate our aim to develop and implement a new model for teaching pathophysiology in nursing education and to evaluate the effects of the new CQA Model on student outcomes and evaluations, descriptive frequencies were calculated and an independent t-test was performed to compare the differences in grades between the previous model and new CQA Model. Quantitative data were analyzed using SPSS. Qualitative data were amalgamated and required content analysis to identify recurring themes.

Student Participant Characteristics

Year 1 and 2 previous model student ages ranged from 20 to 52 (mean 21.6), and 45 to 59 (68%–73%) were white, 4 to 13 (10%) Asian, 3 to 5 (5%) black or African American, 3 (4%) Hispanic, 2 to 3 (3%) 2 or more races, and 3 (4%) unknown or not disclosed. PELL grant recipients ranged from 18 to 35 (29%–41%), and first-generation ranges from 18 to 29 (29%–34%).

Years 1, 2, and 3 CQA Model student ages ranged from 20 to 41 (mean 21.9), and 42 to 49 (59%–74%) were white, 8 to 13 (12%–18%) Asian, 4 to

Findings

To answer our research question, “how do students rate strategies and activities implemented in the CQA Model?” we present the results of the student cumulative course survey questionnaire as follows. Fig. 3 indicates students' rating of course expectations, time, face-to-face activities, evaluation methods, textbooks, and assignments used in the CQA Model using a five-point Likert scale (1 = strongly disagree; 5 = strongly agree).

Course expectations (clear syllabus) were rated strongly agree

Discussion

The development and implementation of the CQA Model were a success. Based on the results, the most important findings from this study are that course and face-to-face activities (lectures, small group) were highly rated by the students and that the student grades statistically had a gradual improvement over the three years of the CQA Model implementation. This is in line with a systematic review by Tan et al. (2018), which concluded that outcome-based education and curriculum design had

Limitations

The current findings were pre-pandemic and are not generalizable beyond the current convenience sample of upper Midwestern, primarily female undergraduate pathophysiology nursing students. The findings should be confirmed on a variety of students and class delivery formats. Further, this study did not explore deeper into students' perceptions of the CQA Model. Future research should employ qualitative measures to understand further how students perceive the CQA Model teaching-learning

Conclusion

The results of our study showed positive support for the CQA Model. Students valued the online recorded videos, as well as the small group activities. Continued and new strategies that support student learning, understanding, knowledge, and application of pathophysiology could increase critical thinking and clinical judgment in the context of nursing practice. The results of this study are in approval of the implementation of CQA Model in nursing pathophysiology courses. However, future studies

Relevance to Nursing Education Science

This CQA Model developed for our nursing undergraduate pathophysiology courses was successful in supporting student learning and outcomes. This CQA Model used in this study may be applicable in other nursing and related professional courses.

Author Contributions

Colsch Renee: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Resources, Writing – original draft, Writing – review & editing, Visualization, Supervision, Project administration; Katherine Tolcser: Conceptualization, Methodology, Investigation, Resources, Writing – review & editing; Suzanne Burke Lehman: Conceptualization, Methodology, Investigation, Resources, Writing – review & editing

Declaration of Competing Interest

None.

References (23)R. Colsch et al.State of pathophysiology in undergraduate nursing education: A systematic review

Journal of Nursing Education and Practice

(2021)

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