No Assessment Criteria

Assignment Two- Written Assessment

Course Name Fundamentals of Clinical Nursing Practice
Course No. NURS 11160
Coordinator: Kate Crowley /Professor Kerry Reid-Searl
Assess No: Two
Type: Written
Due date: Monday Week 9 1600hrs
Word Limit: 2000 words
Total Percentage: 60%
Details The following written assignment is based on a scenario of Stanley Selby.
The video of the scenario is available on the Moodle site and is called ‘Stanley Selby and you as a
first year nursing student’. (The video is broken up into three parts specific to your
assignment). You cannot complete this assignment without referring to the video.

In preparation for the assignment, you will need to download the following documents:
• Fluid balance chart,
• QADD’s vital signs chart,
• Nursing progress notes.

These will be available in the assignment section on the Moodle site. You are then to read the
assignment task set out below and watch the video in all three parts. This assignment has a focus
on patient assessment, infection control, fluid balance charts, vital signs and professional
communication.

Each of these are linked to the following National Safety and Quality Health Service Standards:
• Standard 2 ‘Partnering with Consumers’,
• Standard 3; ‘Preventing and Controlling Healthcare Associated Infections’,
• Standard 5; ‘Patient identification and procedure matching’,
• Standard 6; 'Clinical Handover',
• Standard 9, ‘Recognising and responding to clinical deterioration in acute health care’.

Setting the scene for your assignment

You are a first year nursing student on your first clinical placement. You are on the medical ward
at CQUniversity Hospital. It is the morning shift and you have been assigned the responsibility of
looking after Stanley Selby.
Who is Stanley?

The following are Stanley’s demographic details taken from his patient chart. This is important
information that you will require when completing patient charts for
your assignment.

· Patient’s full name: Stanley Selby

· Date of birth: 21/01/1942

· UR number: 213456

· Address: 16 Greenacres Road Longreach

· Hospital name/ ward: Ward C CQU

· Doctor: Dr William James

· Ht: 172cm

· Wt: 85kg

refers to Stanley’s care plan in the process of delivering the information to you.

Stanley Selby was admitted to the ward last evening with gastroenteritis. Contact precautions are
required. Stanley lives alone after his wife died 2 years ago as a result of a fall. Stanley has a
history of heart failure, arthritis and type II Diabetes. Stanley takes four medications. These
include an antihypertensive medication, a diuretic, an anti- inflammatory and a sedative at night.
All regular medications have been given. Currently his vital signs are stable. Stanley is on a
fluid balance chart and all input and output is being measured. Stanley is tolerating diet and
fluids and has had one episode of diarrhoea at 0500hrs this morning. A specimen has been sent to
the laboratory and we are awaiting results. He will require assistance with mobilising, toileting
and hygiene. Please monitor his input and output and notify Dr James if you have any concerns.

Your responsibilities in looking after Stanley whilst under the supervision of the registered nurse
include attending to his hygiene and toileting needs, assisting with meals, mobilising Stanley
safely, monitoring his vital signs and maintaining his fluid balance chart.

What do you need to do next?

Ensure you provide an introduction to your written assignment (approximately 150 words *).

* The word counts are a guide only.

The first part of your assignment

Please watch the first video on NURS11160 moodle site under written assessment tab entitled:

Video 1: Stanley Selby and you as a first year nursing student.

This section has two parts:
First, you are to explain what clinical handover is and discuss all of the elements that the nurse
should incorporate for an effective clinical bedside handover.
Secondly, describe the potential consequences for the patient and the nurse caring for the patient
when an ineffective handover has occurred from a previous shift.
You should allow 600 words for this part. (*Guide to word count only) Please back up your
information with credible references.


The second part of this assignment

Prior to caring for Stanley, you are conscious that you need to maintain hand hygiene.

Complete the hand hygiene package. Please refer to on-line hand hygiene package available at
www.hha.org.au/home/student-health-practitioners.aspx.
Once completed you will need to print off the certificate. You will need to submit this as Appendix
1 of your assignment. (Explanation for attaching appendices into separate document on moodle unit
page under assessment for this unit section).

Within the body of your assignment provide an explanation on why hand hygiene is important and the
consequences for the patient when breaches occur.

You should allow 200 words for this part. (*Guide to word count only). Please back up your
information with credible references.

The third part of this assignment

You are also aware, based on the clinical handover that Stanley is on transmission based
precautions.

This section also has two parts:
First, explain what transmission based precautions (sometimes referred to as additional
precautions) mean and how they differ from standard precautions. Identify from the video which is
the preferred precaution (i.e contact, droplet or airborne) for Stanley and how you will implement
these in caring for Stanley.
Secondly, watch the video’s and identify the breaches in transmission based precautions when the
nurse is providing care for Stanley. Provide an overview of the breaches in the written part of the
assignment.

You should allow a minimum of 400 words for this. (*Guide to word count only). Please back up your
information with credible references.

The fourth part of the assignment

Your shift progresses. You attend to Stanley’s care. It is now 1130 in the morning. You realize
that you have not completed the fluid balance chart so you go to Stanley to ask about his intake
and output.

Download the fluid balance chart from the Moodle site and document all input and output from
0800hrs until 1130hrs according to what Stanley tells you in the second video entitled:

Video 2: Stanley’s fluids.

This completed fluid balance chart will need to be uploaded as Appendix 2 of your assignment. In
the written part of your paper you should explain what a fluid balance chart is and why Stanley
requires one.

You should allow 150 words for this. (*Guide to word count only). Please back up your information
with credible references.

The fifth part of the assignment

Watch the next video entitled Video 3: Stanley reports feeling unwell.
At 1155hrs Stanley states to you “I am not feeling very well. I am feeling dizzy, hot and not
right”. Stanley appears pale and he has not reported any pain either at rest or with movement.
You then take Stanley’s vital signs. It is 1200hrs and your findings are as follows.
• Respiration 14 breaths per minute.
• Oxygen saturation 95% in Room Air (RA)
• Blood pressure 100/60mmHg Usual BP 120/80 mmHg
• Heart Rate 110 BPM
• Temperature 39.5 degrees celsius
• Conscious state – Alert
• No modifications in use

Record the vital signs on the Adult QADD’s form as downloaded from the Moodle site.

You must ensure you document on and complete all required pages of this tool including adding up the score,

all points of identification and interventions if required.

what your action should be based on the criteria of the score you calculated.

You should allow 150 words for this part. (*Guide to word count only)

The sixth part of your assignment

The situation continues. Based on the above scenario you have sought the assistance of the
registered nurse who then stays with Stanley. The registered nurse asks you to contact the doctor
about Stanley’s current situation. You are to apply ISBAR in communicating to the doctor.

It is 1230hrs and you contact the Doctor who advises that they will review Stanley within 30
minutes. Doctor James reviewed Stanley at 1300hrs and asked for: hourly observations, to remain
resting in bed, continue on the fluid balance chart and for the registered nurse to administer
medication (antipyretic’s) for Stanley’s temperature as per orders on the medication chart.

In the written part of your paper you are to include the communication you gave under the ISBAR
framework.
You should allow 200 words for this part. (*Guide to word count only).

The seventh part of your assignment
You are now required to enter what has occurred in the nursing progress notes. Enter the situation
assuming the time is now 1400hrs and the date is 03/09/2017. Your documentation can commence from
the point of Stanley advising you that he was feeling unwell. All events unfolding from that point
should be documented on the downloaded nursing progress notes adhering to the principles of
professional documentation.

You will submit this as Appendix 4 with your assignment.

Finally provide a conclusion summarising your paper (approximately 150 words).

Summarising what you need to do:
1. View the scenario of Stanley Selby and your written assignment on the Moodle site and watch the
three video’s directly related to this assignment.
2. Explain what clinical handover is and consequences of ineffective handover (600 words). (Word
counts are a guide only).
3. Complete the hand hygiene package and download the completed hand hygiene competency
certificate. Include discussion on why hand hygiene is important and consequences for the patient
if these standards are not met. (200 words). You will need to submit the certificate as Appendix 1.
4. Explain what transmission based precautions mean, the precautions Stanley should have in place
and any identified breaches in those precautions (400 words).
5. Download the fluid balance chart and fill in the fluid balance chart. In the written part of
your paper you should explain what a fluid balance chart is and why Stanley is required one (150
words). Submit the fluid balance chart as Appendix 2.
6. Record the vital signs on the QADD’s form provided on the Moodle site, ensuring you complete all
required components of this document. You will need to submit this as Appendix 3.
7. Explain what your action should be based on the criteria of the score on the QADD’s form (150
words).
8. Apply ISBAR in communicating to the Doctor about Stanley. (200 words).
9. Complete the Nursing progress notes for the situation using the SOAP format. You will need to
submit this as Appendix 4.

Notes to Students
The format of your assignment should be as follows:
• A title page
• Contents page
• An introduction
• A main body with the following headers
• Clinical handover
o What clinical handover is
o Potential issues with ineffective handover
• Hand hygiene
• Transmission based precautions
o What transmission based precautions are
o Identified breaches
• What fluid balance charts are and why Stanley is required one.
• The nurses actions based on the criteria of the score on the ADDs form
• The application of ISBAR
• Conclusion
• Reference List
• Appendices on separate document

Appendix 1: Hand hygiene certificates

Appendix 2: Completed fluid balance chart

Appendix 3: Completed Q-ADD’s chart

Appendix 4: Completed nursing progress notes

*All students should refer to the Marking Criteria available on the course Moodle site
*Please note your hand hygiene certificates, progress notes, Fluid Balance chart, and Adult ADDS
form (documents in the Appendix) will need to submitted as a separate document. Submit
as word document when you upload them to the assignment submission point.

The written sections (the main body)of your assignment must be in word.

The simulation assessment activity will occur on the last day of your residential school or clinical skills sessions.

The skill audit is non graded as pass/fail. (Please note students must also attend the entire 24 hours of the residential school to pass this component of the course). The skills that will be assessed include:

1. Hand hygiene
2. Taking and accurately recording vital signs including: respiration, pulse, temperature, blood pressure and pulse oxygenation.
3. Ten safety questions

No Assessment Criteria

This is the summative quiz relating to the content of the whole 12 week unit. This quiz is compulsory for all students. This quiz is worth 40% of the grade and will be open for students to access on Friday of Week 13. The quiz will be open for a 24 hour period only but once you commence the quiz you will have two hours to complete it.

Online Quiz.