Teacher's+Guide

Teaching Body Surface Area of Pediatric Patients to Nursing Students Toby Embry MSN, RN, CNS and Kathleen Shea MSN, RN The teaching unit is based on a Wiki page entitled //Calculating BSA in Nursing// (http://bsainnursing.wikispaces.com/What+is+body+surface+area+%28BSA%29%3F)//.// The purpose, philosophy, and learning objectives of the unit are posted in the Wiki and in this document. Nurse educators have difficulty aiding students in the acquisition of concepts surrounding body surface area (BSA) in relation to medication administration for pediatric patients. The BSA of an adult patient is quite different to that of the pediatric patient. That said, the accuracy in dosage calculation becomes even more of a priority when calculating and administering medications to infants and children (Gray Morris, 2010). Medications given in pediatric nursing units are based on BSA. Therefore, errors in calculating BSA can be detrimental to patient outcomes. It is reported that 1 in 15 hospitalized pediatric patients are harmed as a result of medication errors. The margin of error is much less in children than in adults. The rate of actual, potential, and preventable adverse drug events is three times higher for pediatric patients (Gray Morris, 2010). Nursing students struggle with the concept of BSA and its importance in medication administration for infants and children in comparison to the same concept of BSA related to adult patients. Small discrepancies and miscalculations may be dangerous because of the size, weight, and BSA of the infant and child (Gray Morris, 2010). Additionally, the physiological capabilities of the pediatric population such as the lessened ability to metabolize medications and immaturity of systems differ when compared to the adult patient (Gray Morris, 2010). The purpose of this teaching module is to provide nurse educators with the tools to present the topic of medication calculations using the concept of BSA in the pediatric population. A constructivist theory of education will support students in schema acquisition related to this challenging nursing concept of BSA and medication calculations in the pediatric setting. While the underlying philosophy of this project is based on Piaget’s Developmental Theory, principles of Adult Learning Theory will be utilized as well. The principles of adult learn theory can be used in the design of technology-based instruction to make it more effective. Knowles’ Theory of andragogy allows educators to structure lesson plans that are part of a reliant learning environment for adult students (Fidishun, N.D.).The formalization of the theory of constructivism is generally attributed to Jean Piaget, who articulated mechanisms by which knowledge is internalized by learners (Singer & Revenson, 1996). Piaget suggested that through processes of //accommodation// and //assimilation//, individuals construct new knowledge from their experiences. When individuals assimilate, they incorporate the new experience into an already existing framework without changing that framework (Piaget & Inhelder, 2000). This may occur when individuals' experiences are aligned with their internal representations of the world, but may also occur as a failure to change a faulty understanding. According to the theory, accommodation is the process of reframing one's mental representation of the external world to fit new experiences. Accommodation can be understood as the mechanism by which failure leads to learning. Piaget's theory covered learning theories, teaching methods, and education reform (Piaget & Inhelder, 1996). Two of the key components that create the construction of an individual’s new knowledge are accommodation and assimilation. Assimilating causes an individual to incorporate new experiences into the old experiences. This causes the individual to develop new outlooks, rethink what were once misunderstandings, and evaluate what is important, ultimately altering their perceptions. The goal of the education module is to accommodate understanding of the basic BSA calculations and aide in the assimilation of these concepts toward the pediatric population utilizing a constructivist approach. It is important to note that constructivism is not a particular pedagogy. In fact, constructivism is a theory describing how learning happens, regardless of whether learners are using their experiences to understand a lecture or following the instructions for assembling a piece of furniture. In both cases, the theory of constructivism suggests that learners construct knowledge out of their experiences. However, constructivism is often associated with pedagogic approaches that promote active learning, or learning by doing. Piaget's theory of constructivism argues that people produce knowledge and form meaning based upon their experiences (Singer & Revenson, 1996) This learning module will be constructed as three separate 90-minutes units in which nursing students will be guided through the concept of body surface area, attain skills to calculate BSA, and apply these skills and concepts in calculating medication problems for pediatric patients. Each unit of this learning module will have specific learning objectives to guide students toward successful understanding and demonstration of concepts. Students will be required to transfer knowledge gained from one unit to the preceding units as each unit builds upon the previous set of skills. Technology will be utilized in each unit of the entire learning module as a platform to strengthen concepts, provide rationale, and opportunities for student practice of specific skills. At the end of three 90-minute sessions, students will be able to differentiate between body surface area calculations for pediatric patients and adult patients as well as demonstrate skill acquisition within the nursing setting. Furthermore through guided practice, students will demonstrate the correct method for calculating body surface area in a pediatric patient as well as describe the concept of BSA in relation to medication administration. Through the course of each 90-minute session, nursing instructors will provide learning activities that demonstrate the concept of body surface area. Therefore, by constructing the learning environment, educators will provide activities that will require participants to apply these concepts in a simulated setting using technology and static mannequins. Supplies needed for the unit include: computer, internet access, newspaper, measuring tape, masking tape, string, scissors, calculator, paper, pencil and pen. Optional: baby doll or pediatric patient simulator. Each student will receive an invitation to join the Wiki prior to participating in the class sessions. Module One- Lesson 1 Surface area and volume website link will introduce the student to the concepts of surface area and volume. The participant will choose the //Learner// tab (upper left side of site) and will be introduced to the three dimensional polyhedral to experiment with the concepts of surface area and volume. The illustrations represent the width, height, base width, prism height, and base depth. The activity in this lesson allows learner to change dimensions of a polyhedron and view a visual representative of the differences in size and shape. The activity calculates the volume and the surface area of the polyhedral. Module One-Lesson 2 This lesson will introduce BSA Formulas. An interactive discussion will follow presentation. The web link, **//Surface Area Formulas for Shapes//**, provides an activity that teaches how to calculate the surface area of common solids. Each section has an interactive quiz to assess student’s understanding. Module One-Lesson 3 This lesson will address the definition of Body Surface Area and differentiate between the BSA of an adult and that of a child. Illustrations are included on the Wiki page to depict the BSA differences between adult and children, additionally, web links are provided so that students can explore the differences in medication dosage, practice the steps involved in pediatric BSA calculation, and differences in BSA among adults, children and infants. The pediatric dose calculator (nomogram) is included in the Learner Activities section of the lesson, so that learners will be able to practice using this nomogram to calculate pediatric doses. Module Two-Lesson 1 This lesson will teach the vocabulary associated with pediatric medication calculations. The Web Link provides important information regarding medication safety. The Learner Activities link provides students with an article focused on preventing medication errors in pediatrics. Module Two-Lesson 2 The learner activities include E Math Group, a math discussion group site to assist students in solving pediatric math problems based on body surface area and weight. The site includes a discussion board and question and answer forum for math issues. The next activity is based on as website named Pharmacology Math. This interactive site provides many types of medication problems and their answers plus a detailed description of key information needed to solve problems. Module Two-Lesson 3 This lesson’s focus is on calculating pediatric medication dosages, students will demonstrate your knowledge by participating in a body surface area activities. The student will build a baby using newspaper and calculate the body surface area. Module Three- Lesson 1 This lesson‘s Learner Activity includes a book chapter on the subject of Dosage Calculations. The text includes the apothecary system, Clark’s Rule, Fried’s Rule and Young’s Rule. Information is a review of concepts learned on the wiki site and prior knowledge. There will be hand outs designed to emphasize concepts and provide detailed instructions regarding learning activities. These handouts will be online for student’s use; they may be accessed and printed by student prior to class. The students will be assessed based on their performance of the skill at the end of the teaching unit. The student will also turn in a portfolio of their work that was completed during the teaching unit. Worksheets, practice problems and activities will be included in the student portfolio.
 * Teacher’s Guide**
 * Purpose**
 * Philosophy**
 * Learning Objectives**
 * Technology Requirements**
 * Description of Activities**