Approved by University Studies Sub-Committee April 6, 2005. A2C2 action pending.
COURSE NUMBER AND TITLE: N392 CARDIOVASCULAR RISK PREVENTION
PLACEMENT IN CURRICULUM: NURSING ELECTIVE; Required course for some Health and Human Performance majors
COURSE CREDIT: 3 semester credits
COURSE OVERVIEW: Designed to identify key health care provider roles in the primary and secondary prevention of cardiovascular disease (CVD). Major risk factors will be analyzed, and strategies for modifying each will be developed. Research guidelines will be used to focus on how public health recommendations are made for the general population and high risk groups. Major cardiovascular diseases will be discussed with a focus upon the evidence based practice guidelines for each. Students will also focus upon their own lifestyles while exploring the long-range effects of their habits. Current theories of behavior change will be applied to risk factor modification. Valid and reliable sources for health education will also be discussed.
This course is approved for Critical Analysis in the Unity and Diversity component of University Studies and helps students use analytical problem-solving skills as they develop evidence-based interventions for CVD. Students will complete course outcomes and learning activities that promote students’ abilities to:
a. evaluate the validity, and reliability of information;
b. analyze modes of thought, expressive works, arguments, explanations, or theories;
c. recognize possible inadequacies or biases in the evidence given to support arguments or conclusions; and
d. advance and support claims.
Description of course requirements and learning activities that promote students’ abilities to meet the outcomes of the critical analysis component of Unity and Diversity in University StudiesCourse Outcomes and Critical Analysis objective / Course activities / Example of Student assignments and grading
5. Analyze sources of health information for validity and reliability
6. Identify evidence-based practice guidelines for management of hypertension, hypercholesterolemia, unstable angina, acute coronary syndrome, congestive heart failure, and peripheral vascular disease
CT objective: evaluate the validity and reliability of information / Analysis of news (TV and print) in class; analysis of a website for patient education using criteria; review of websites that critique websites; discussion board for analyzing interactive websites using principles of health education / Written analysis of interactive website for possible use as patient education
Criteria addressed are authority; accuracy; objectivity; currency; coverage of topic –this first assignment is 10 points; they are again graded on their ability to evaluate patient education materials (written and internet) as part of the criteria for their teaching module. 100 points
2. Explain the factors affecting health behavior and the complexity of behavioral change
4. Plan strategies for modifications of the following risk factors- blood pressure, smoking, cholesterol, weight, exercise, stress, metabolic syndrome
CT objective: analyze modes of thought, expressive works, arguments, explanations, or theories / Using the transtheoretical model of change, develop a teaching plan through all the stages for one risk factor.
Case study analysis of risk factor modifications / After extensive work in class, students develop a teaching project using the trantheoretical model for behavior change. Project worth 100 points. Parts of written project on separate sheet. This is approximately 40% of their grade
3. Using current research, delineate the risk factors highly correlated with cardiovascular disease
CT objective: Recognize possible inadequacies or biases in the evidence given to support arguments or conclusions; / Research reviews each week for last half of class with class discussion of strengths and weaknesses; comparison to other sources of information and other research / Each student presents one research study; guidelines include: appropriate article (original research published in refereed journal, author credentials; funding sources);
Research approach (sampling techniques, type of research, definition of variables, results);
Analysis of strengths and weaknesses (discussion; consistency with other research findings; applicability to other groups; research design)
Engaging students in discussion of applying research to what studying in class
10 points graded exercise
1. Identify the impact of cardiovascular disease upon the US population
7. Analyze the emerging claims of new risk factors
CT objective: advance and support claims / Class discussion of different approaches to behavioral change after students have tried three different approaches.
Pick an emerging risk factor and propose how this fits into current understanding of biological, epidemiological, and interventional research.
Class discussion of popular sources of information used by patients. / Students carry out a behavioral contract throughout the semester using an interactive website, a self developed contract and behavioral plan, or a paper and pencil behavior change form that is fill in the blanks . At the end students are given the results of each group, and in class develop the pros and cons of each approach from their experience.
In the last class, students bring a research study on an emerging risk factor assigned to them. In groups of three, they write a summary comparing the definitions, research questions, type of research, and the similarities and differences of the results.
At this time, this exercise has not been graded, but used as a way to move students from individual research studies to looking at similarities and differences in several.
COURSE OUTCOMES: (letter in parenthesis denotes Critical Analysis objective met by course outcomes)
1. Identify the impact of cardiovascular disease upon the U.S. population.(d)
2. Explain the factors affecting health behavior and the complexity of behavioral change.(b)
3. Using current research, delineate the risk factors highly correlated with cardiovascular disease.(c)
4. Plan strategies for modifications of the following risk factors- blood pressure, smoking, cholesterol, weight, exercise, stress, metabolic syndrome.(b)
5. Analyze sources of health information for validity and reliability.(a)
6. Identify evidence-based practice guidelines for management of hypertension, hypercholesterolemia, unstable angina, acute coronary syndrome, congestive heart failure, and peripheral vascular disease.(a)
7. Analyze the emerging claims of new risk factors.(d)
TOPICAL OUTLINE
A. Cardiovascular disease in US.
1. Statistics
2. Epidemiology of Cardiovascular disease
3. Epidemiological research methods
4. Criteria for causation in CVD research
5. Prevention levels; natural history of disease
6. Selection of screening levels for risk factors
7. Women and heart disease
B. Behavioral Change
1. Health belief model
2. Self-efficacy
3. Transtheoretical Model of Change
4. Motivational Interviewing
5. Behavioral strategies
C. Health Information
1. Resources, readability, reliability
2. Web site analysis, professional and patient education
3. Interactive sites
4. Research analysis
D. Personal Risk Factor Analysis
1. Family history
2. Age, sex
3. Blood pressure
4. Smoking
5. cholesterol level, nutritional analysis
6. weight, waist-hip ratio, body fat analysis
7. exercise level
8. stress
9. diabetes
10. alcohol intake
E. Risk Factor Modification Strategies
1. Weight Component
2. Lipid Component
3. Exercise Component
4. Smoking Component
5. Metabolic Syndrome Component
F. Management of Diseases of the cardiovascular system
1. High Blood Pressure
2. Unstable Angina
3. Acute coronary syndrome
4. Congestive heart failure
5. Peripheral vascular disease
G. Quality of Life Issues
H. Trends and emerging risk factors in research
LEARNING PLAN
A. STRATEGIES
Lecture
Tests
Personal risk factor assessment
Behavioral change module
Case studies
Discussion
Analysis of cardiovascular information in the news
Research reviews
Website analysis of sites for consumer information
Teaching module on a risk factor
B. COURSE REQUIREMENTS
1. Research article review for class on a component of CVD, risk factor or disease intervention. Student presents the research question, background, study design, and results; identifies the strengths and weaknesses of the research design and conclusions, identifies similarities and differences to what discussed in class or other classes, and facilitates a question and answer time from the class. (c. recognize possible inadequacies or biases in the evidence given to support arguments or conclusions)
2. Two web-based assignments: a) an analysis of a website for patient education using the following criteria-authority, accuracy, objectivity, currency, and coverage of the topic and b) a discussion board activity that posts interactive websites for evaluation using principles of health education as a background. (a. evaluate the validity and reliability of information)
3. Using the Transtheoretical Model of Change, students develop a teaching plan through all the stages identifying patient characteristics, processes of change, and interventions (objectives, content, and strategies) for one risk factor.(b. analyze modes of thought, expressive works, arguments, explanations, or theories;
4. In class, pick an emerging marker or risk factor for CVD and propose how this fits into current understanding of biological, epidemiological, and interventional research.
5. Case study analysis in class for most of second half of semester.
6. Develop behavioral contract and compare to options- develop own, use prepared format, use long-term interactive site on web. Class discussions of pros and cons of each after trial period.( d. advance and support claims)
7. Class discussion of popular sources of information used by patients ( d. advance and support claims)
C. TEXTBOOKS:
See attached websites where reading assignments are made; readings are the published guidelines in various CVD research areas where consensus from several organizations and over several years of accumulating data from various research studies has generated the newest published guidelines.
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, May 2003
Heart Disease and Stroke Statistics- 2005 Update
Clinical Guidelines on the Identification, evaluation, and Treatment of Overweight and Obesity in Adults June 1998
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults May 2001
Dietary Guidelines Advisory Committee Report, 2005, basis for Dietary Guidelines for Americans 2005
Other sites listed on Reading assignment (see attached)
D. EVALUATION OF LEARNING
Quizzes and final:
92-100% -A
83-91% -B
74-82% -C
65-73% -D
A behavioral contract with oneself is also required. Pass/fail
Points for the teaching module paper will be added into the points for the final grade after quizzes passed at a C level.
Cardiac Risk Prevention Assignment Guidelines (10 points)
The prevention and management of cardiac risks is research based. Recommendations for clinical practice on risk factors and interventions-screening tests, counseling interventions, level of risk, etc.- should be supported by theory as well as research. In order to explore research-based guidelines, you are asked to complete the following assignment.
1. Each student will sign up for one risk factor, can be an emerging risk factor or an independent risk factor .
2. Locate an article from a professional refereed journal that addresses some aspect of the risk factor you chose. The article should be one of the following types:
a. A report of the original research findings. It should describe in the article the purpose, study population characteristics, methods, results, and discussion. Do not use an article that cites this research as a secondary source.
b. A meta-analysis of a number of studies on your risk factor. It should describe the similarities and differences of the individual studies and the major conclusions that can be drawn from a review like this.
c. Additional reports of recommendations from a health care or governmental agency that is publishing evidenced-based guidelines from expert panels (students are encouraged to search for these guidelines via the internet). Do not use the guidelines presented in class.
3. Complete a brief annotated bibliography. Include the article citation (use APA format) and 2 or 3 sentences describing the findings/ recommendations and how they can be used by health care providers in practice. Also turn in a copy of the article at the time you present in class.
4. During the week your topic is covered in class, briefly share with the class the knowledge you gained from reading the article ( up to 5 minutes). Cover the journal published in, authors credentials, sampling techniques, results, consistency with other research findings you are familiar with, and questions you have regarding the research findings or applicability to other groups. You will want to be able to field questions from the class.
This assignment is worth 10 points and is due in class on the date of the risk factor for which you have chosen. 2 pts- appropriate article
3 pts- ability to summarize research and pick out relevant data
3 pts- analysis of strengths and weaknesses in the study
2 pts- ability to engage students in applying the research to what learning in class
Teaching Project Guidelines (100 points)
DESCRIPTION OF TEACHING PROJECT-30 points
1. Description of the CVD risk factor 10 points
Describe in detail the effect of this risk factor on CVD. Use scientific data to support your claim of the impact or importance of this risk factor.
2. Description of target population 10 points
Common characteristics: age, previous attempts, developmental level, health care setting or educational setting
3. Description of stages of change as applied to your risk factor 10 points
Description of common client behaviors at each stage;
DESCRIPTION OF THE TEACHING PLAN-50 points
1. For each stage of change (precontemplation, contemplation, preparation, action and maintenance) 10 points for each stage; each stage must have the following three parts.
A. Objectives - appropriate to behavior and stage of change addressing (use at least two domains-knowledge, affective, psychomotor)
B. Topical outline and your rationale for inclusion at this stage of change. Explain how this information is critical at this stage. (this is content or knowledge)
C. Teaching strategies- activities and approaches appropriate for stage of change you are addressing. Be specific with activities, strategies and use the processes of change as appropriate to your stage.
DEVELOPMENT OF RESOURCES-PROFESSIONAL AND PUBLIC EDUCATION- 20 points
Evidenced based resources for the risk factor 20 points
Include both professional references and sources of patient educational material, including websites as appropriate. List professional and public education material in separate sections (10 points for each section)
If using pamphlets developed by you or from an organization, please include.
Winona State University
College of Nursing and Health Sciences
Department of Nursing