Metacognition with Davis Advantage Laying a Strong Foundation for Higher-Level Learning
Karin Sherrill, MSN, RN, CNE, ANEF, FAADN
What is Metacognition? For many years, neuroscientists have studied the human brain to determine how a person learns. Applying studying strategies such as spacing, effortful work, repetition, growth mindset, retrieval practice, chunking, interleaving, cognitive wrapper, reflection, calibration, and self-regulation of learning are proven to be highly effective. Metacognition provides a means for educators to focus on cultivating and strengthening a student’s capacity for applying clinical judgment to decision-making. By using brain-focused, evidence-based, student-centered, and objective-driven learning activities, your students will obtain a higher-level of understanding. The andragogy of Davis Advantage is built upon the strategies of metacognition. Let’s explore how it works.
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Assignment Methodology & Path for Success Selecting and assigning Personalized Learning activities is based on curricular content, objectives, and learning outcomes. An instructor should consider spacing of assigned activities so that they promote effortful work. If the student is overwhelmed, effort will be diminished. Deep learning is about allowing time to process material. This cannot occur when students are pushed to learn too much, too quickly. § 4417_Ch30_568-590 13/04/16 4:44 PM Page 570 4417_Ch30_568-590 13/04/16 4:44 PM Page 571
Consider re-assigning properly spaced activities that students have previously completed. Repetition is a strategy for metacognition. § Stimulate a growth mindset by inspiring students to take on challenges. Assign “bonus” activities and motivate by providing positive encouragement.
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Chapter 30 Coordinating Care for Patients With Cardiac Disorders
Unit VI Promoting Health in Patients with Circulatory or Perfusion Disorders
A variation of unstable angina is variant , or Prinzmetal’s, angina . The blockage of blood flow in this disorder is caused by coronary artery spasm rather than plaque formation, but commonly atherosclerotic changes are present. It typically occurs at rest and in clusters. Interestingly, it normally occurs at night between midnight and 8 a.m.
develops when there is an imbalance between supply and demand of oxygen-rich blood to the heart tissue resulting in insufficient oxygen to meet the demands of the myocardial tissue . Infarction, or cell death, occurs when that imbalance is severe or prolonged, which causes irreversible damage. The primary patient complaint is chest pain, also called angina . Angina is classified into two categories, stable and unstable angina. Stable angina is chest pain or discomfort that is associ- ated with physical activity. It is typically linked to fixed plaque formations. Symptoms of stable angina are often alleviated with rest and/or medications. Nitrates such as nitroglycerin that dilate the coronary arteries, improving oxygen-rich blood flow to the heart, are typically prescribed for angina. Unstable angina refers to chest pain that can occur at rest. Of the two types of angina, unstable angina is the most con- cerning. It is identified as the initial phase of acute coronary syndrome (ACS), defined as a disorder caused by an acute decrease in blood flow through the coronaries to the myocar- dial tissue, and can be a precursor to MI. It should be treated as an emergency. Unstable angina is usually prolonged and may not be relieved with medication. In addition to nitroglyc- erin, these patients may z medications such as morphine. Supplemental oxygen is typically necessary.
FIGURE 30.1 Layers of the arterial wall.
Management Medical Management
Tunica adventitia
Tunica media
Tunica intima
As stated previously, the formation of plaque within the blood vessels is a silent process. Often CAD is suspected only when the individual presents with clinical symptoms. The diagnosis is made on the basis of clinical presentation and diagnostic findings. Laboratory Tests Laboratory tests diagnostic for CAD are summarized in Table 30.2. Many of the blood tests performed assess for the presence of risk factors for CAD development, such as lipid profiles, inflammation, and coagulation studies. Lipid profiles evaluate total cholesterol and triglyceride levels as well as the ratio of LDL to high-density lipoprotein (HDL) to determine if hyperlipidemia is present. Specific cardiac enzymes are used to rule out MI.
Smooth muscle
Endothelium
Basement membrane
Internal elastic membrane
External elastic membrane
part of the vessel, forming plaque. The plaque deposits in- crease in size over time causing narrowing of the coronary arteries, which impedes oxygen-rich blood flow to the heart (Figure 30.2). The next and most dangerous step in the development of atherosclerosis is potential plaque rupture. When that oc- curs, platelets aggregate on the ruptured plaque surface. The coagulation cascade is initiated, and thrombus formation is
stimulated. This further decreases or obstructs blood flow altogether leading to unstable angina, myocardial infarction (MI), or sudden cardiac death. Clinical Manifestations The clinical manifestations of CAD are virtually silent until the artery is approximately 40% blocked by plaque. Ischemia
Table 30.2 Laboratory Tests Diagnostic for Coronary Artery Disease
Laboratory Tests
Rationale
Electrolyte imbalances along with increases in renal or hepatic laboratory values may indicate damage caused by poor perfusion or may indicate the presence of risk factors for heart disease. Laboratory values included in the comprehensive metabolic profile include: l Glucose, calcium, sodium, potassium, carbon dioxide, chloride Laboratory values helpful in assessing renal function in addition to electrolytes, sodium, and potassium include: l BUN, creatinine, total protein Laboratory values helpful in assessing hepatic function include: l ALP, ALT, AST, bilirubin, total protein, and albumin
l Comprehensive metabolic panel to establish a baseline, assess electrolyte balance, and assess renal and hepatic functions
l Glucose (80–100 mg/dL) l Calcium (8.5–10.9 mg/dL) l Albumin (3.9–5.0 g/dL)
l Total protein (6.3–7.9 g/dL) l Sodium (135–145 mEq/L) l Potassium (3.5–5.0 mEq/L) l Carbon dioxide (20–29 mmol/L) l Chloride (96–106 mmol/L) l Blood/urea/nitrogen (BUN) (7–22 mg/dL) l Creatinine (0.5–1.3 mg/dL) l Alkaline phosphatase (ALP) (44–147 IU/L) l Alanine aminotransferase (ALT) (8–37 IU/L) l Aspartate aminotransferase (AST) (10–34 IU/L) l Bilirubin (0.2–1.9 mg/dL) l Inflammatory markers such as C-reactive protein l Less than 1.0 mg/L = low risk for CVD l 1.0–2.9 mg/L = intermediate risk for CVD l Greater than 3.0 mg/L = high risk for CVD
FIGURE 30.2 A comparison of a normal artery with an artery narrowed by athero- sclerotic plaque deposits on the wall.
Artery cross section
Normal artery
Endothelium
Normal blood flow
Artery wall
Narrowing artery
Atherosclerotic plaque
Assess for the presence of inflammation and/or derangements in clotting, which are both implicated in the development of atherosclerosis
Damaged endothelium
Abnormal blood flow Atherosclerotic plaque
Narrowed artery
Continued
Pre-Assessment Davis Advantage pre-assessments are designed for students to reflect on existing knowledge. Encouraged to complete assigned reading, students then take a short quiz that allows for retrieval practice. If unsuccessful at obtaining the benchmark score, students are prompted to complete the assigned materials that expand understanding. § Ask students to reflect on incorrectly answered questions by challenging them to find the correct answers in the text.
Personalized Learning Activities Each Davis Advantage activity includes an animated mini-lecture video and interactive activity that are focused on a particular topic or concept to engage the students. The modules are “chunked” together, supporting how a brain learns best. Chunking information offers bite-sized pieces of information at a time, presented in a reflect-learn-apply-reflect format. This strategy supports interleaving , a concept that interrupts a person’s ability to forget. As the brain begins to purge new information, it is forced to apply the new material in a different format. This migrates the new material to long-term memory.
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Post-Assessment After the completion of the video and activity, students complete a short post-assessment quiz. This cognitive wrapper reinforces the “chunk” of material in the video and activity.
The application and analysis level items found in the post-assessment require reflection and calibration within the brain. The student must reflect on the material learned to answer the items, and calibration allows the student to determine what was not learned that should have been.
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Real-Time Results After the assignment is completed, the student receives feedback on their progress. This provides self-regulation of learning . Students can revisit any module for additional practice and repetition .
Improve Student Outcomes & Practice Readiness Purposeful learning, knowledge retrieval, chunking of material, and cognitive wrappers serve as the structure of Davis Advantage’s Personalized Learning assignments. Using metacognition empowers students to think about their own learning to improve retention of material, apply nursing concepts into real-world practice, and strengthen clinical judgment.
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About the author Karin Sherrill, MSN, RN, CNE, ANEF, FAADN has been a nurse educator for over 30 years. She works as a nursing education consultant, supporting faculty in creating better nurses.
References Agarwal., P., & Bain, P. (2019). Powerful teaching: Unleash the science of learning. Jossey-Bass. Brown, P., Roediger, H., & McDaniel, M. (2014). Make it stick: The science of successful learning. Belknap Press of Harvard University. Doyle, T., & Zakrajsek, T. (2019). The new science of learning, 2nd ed. Stylus. Dunlosky, J. & Rawson, K. (2019) The Cambridge handbook of cognition and education. Cambridge: Cambridge University Press.
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