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NURS11160 Fundamentals of Clinical Nursing T2 2019

Assignment Two - Written Assessment

Assessment Item Two addresses unit learning outcomes one and three.

1. Apply the principles from the nursing process to deliver evidenced based, person centred nursing care to individuals and families at novice level

3. Relate the significance of the Nursing Midwifery Board of Australia (NMBA) standards for practice and specific National Safety and Quality Health Service Standards to nursing practice. 

Details :  The following written assignment is based on a scenario of  Mr Harold McDonald. The video’s of the scenario are available on the Moodle site and are called  Mr McDonald and you as a first year nursing student’. (The video is presented in 3 parts specific to your assignment). You cannot complete this assignment without referring to the videos.

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 are available in the assignment section on the Moodle site. You are then to read the assignment task set out below and watch the videos.  This assignment has a focus on patient assessment, fluid balance charts, vital signs and professional communication.

Each of these are linked to a number of the National Safety and Quality Health Service Standards (NSQHSS) and align with unit learning outcomes. The relevant standards should be considered when developing your discussion.

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 Mr McDonald under the supervision of the Registered Nurse.

Who is mask-ed character?

The following are demographic details taken from the patient chart. This is important information that you will need when completing patient charts for your assignment.

Name: Mr Harold McDonald

DOB: 21/01/1940

Address: 133 Atlas Street, Mackay, QLD

Weight:   88kg

Height:  167 cm

UR: 6332874

ISBAR clinical handover for shift change

It is 0700hrs and you have just started your shift. Clinical handover has begun. You receive the following information at the patient’s from the nurse who is about to go off duty. The nurse refers to the patient’s care plan in delivering the information to you.

Situation: Mr Harold McDonald was admitted to the medical ward from the emergency department at 0430hrs today. Harold has a respiratory tract infection and is finding it more difficult to breathe than normal. He is also having intermittent temperatures that make him feel unwell.

Background:  Seasonal Asthma, Diabetes (Non Insulin dependent), hypertension, prostatic hypertrophy.  Medications include oral hypoglycaemics and anti hypertensives. Allergic to pollens and metoclopramide.

Assessment: On examination Mr McDonald is sitting up in bed, he is alert, but reports feeling tired. He has mild work of breathing with some intercostal recession. Mr McDonald mobilises independently usually though he does not feel like moving much at the present time.

The vital signs were recorded at 0630am as follows:

RR: 22

Oxygen Saturation: 93% on R/A

BP: 130/80 Default systolic BP 120mmHg

HR: 98

Temp: 37.9

Pain at rest: 3/10. With coughing and movement: 5/10

Recommendations: Monitor vital signs and pain score; administer oxygen if saturations drop below 92% in R/A as ordinarily his saturation are above 95% in RA. Transmission based precautions must be implemented. Assist with mobilising as needed, monitor input and output on the fluid balance chart. Encourage mobilising as tolerated by the patient. The medical team, under Dr James, will review this morning at around 1030am.

Your responsibilities in looking after Mr McDonald whilst under the supervision of the registered nurse include:

•       Monitor vital signs. Minimum 4/24

•       Assisting with hygiene and toileting needs as required;

•       Maintain and record input and output on FBC

•       Assist with meals as required;

•       Assist patient to mobilise safely;

•       Prevent pressure injury and falls

What do you need to do next?

Title page and general instructions

Create a title page for the assignment and include all relevant information including student name, number, unit name and number, assignment number and word count.

Ensure you use 12-point font and double line spacing.

Please also ensure you include a contents page as the use of headings is encouraged.

 
The first part of your assignment

Open your assignment with an introduction then move into the required tasks as per instructions (allow 200 words).

The second part of the assignment – Clinical Handover

This section has two parts. Please watch the “Handover Video” on moodle:

First, you are to explain what clinical handover is and critique the handover you observe in the video. Please consider each element of ISBAR.

Secondly, describe the potential consequences for the patient and the nurse caring for the patient in the video’s when an ineffective handover may have occurred from a previous shift.

Ensure you refer to the appropriate NSQHS Standard 2^nd ed, when developing your discussion.

You should allow 500 words for this part. (*Guide to word count only)

Please back up your information with credible references.

The third part of this assignment – Infection Control

This section has multiple parts:

You are aware, based on the clinical handover, that Mr McDonald is on transmission-based precautions and adhering to the five moments of hand hygiene form part of your responsibilities when caring for Mr McDonald.

Complete the hand hygiene package on Hand Hygiene Australia (HHA). Please click on “On-line Learning” tab. You may need to register if this is your first visit to HHA.  Please search for and then complete the “Hand Hygiene Student Health Practitioners Online Learning Module”

https://www.hha.org.au/

Once completed you will need to print off the certificate.  You will need to submit this in Appendix A of your assignment.

In the body of your assignment:

Firstly, explain what ‘transmission-based precautions’ are (sometimes referred to as additional precautions) and how they differ from standard precautions. Identify from the “Handover Video” on moodle what the preferred precaution is (i.e contact, droplet or airborne) for Mr McDonald and how you will implement this in caring for the patient.

Secondly, after watching the “Handover Video,” you are to identify the breaches in transmission-based precautions when the nurse is providing care for Mr McDonald . Provide an overview of the breaches in the written part of the assignment.

Ensure you also refer to the appropriate NSQHS Standard 2^nd ed, when developing your discussion.

You should allow a minimum of 500 words for this.  (*Guide to word count only).

Please back up your information with credible references.

The fourth part of the assignment – Fluid Balance

After breakfast is delivered you are aware you need to document input and output on the fluid balance chart. It is now 0930 am in the morning. Watch video “Fluid Balance Chart Part A”.

In the written part of your assignment you are to briefly explain what a fluid balance chart is and why Mr McDonald would require one.

Ensure you also refer to the appropriate NSQHS Standard 2^nd ed, when developing your discussion.

You should allow 200 words for this. Please back up your information with quality references.

At 1500hrs you need to go back and complete the fluid balance chart for the remainder of your shift. (See “Fluid Balance Chart Video, Part B”).

Download the fluid balance chart from the Moodle site and document all input and output from 0700hrs until 1500hrs according to what you hear in the video. This completed fluid balance chart will be Appendix B of your assignment.

The fourth part of the assignment - QADDS

Watch the video on moodle “The patient feels unwell”. At 1030hrs you go into Mr McDonald’s  room and he states he is “feeling worse than before.”

You then take  Mr McDonald vital signs.  It is 1035hrs and your findings are as follows.

Respiration: 24

Oxygen saturation: 92% on room air

Blood pressure actual: 132/80.  Use the default systolic BP to determine a score for actual BP.

Pulse: 101

Temperature: 38.2

Conscious state: Alert

Pain score: 6/10. Functional Activity Score: 6/10

No modifications in use at the present time.

Document the vital signs on the Adult QADD’s chart you downloaded from the Moodle site. Include all points of identification on the chart. You are to add the score and complete the documentation on the QADDS chart. You will need to submit this as Appendix C.

In the written section of your assignment you then need to explain,

·       what action should be taken based on the score you calculated, and

·       what nursing action you would take in regards to Mr McDonald’s QADDS and complaints  of pain.

You should allow 200 words for this.    

 
The fifth part of your assignment

Based on the above scenario you have sought the assistance of the registered nurse. It is 1048 and when you report  Mr McDonald current situation to the registered nurse.

The RN requests that you inform the medical officer on-call.  

In the written part of your paper you are to include the communication you gave to the medical officer under the ISBAR framework.

You should allow 200 words for this.

The medical officer, Dr James, advises the following over the phone.

·       Increase vital signs to hourly

·       Apply oxygen if needed to maintain saturations 92% and above

·       RN to administer analgesia for comfort

·       Increase oral fluids as tolerated

·       Dr James will take bloods and order a chest xray when he attends. He will be there within half an hour.

The sixth part of your assignment

You are now required to enter what has occurred in the nursing progress notes using SOAP format. Enter the situation assuming the time is now 1100 hrs and the date is 20/7/19. Your documentation can begin from the point of Mr McDonald advising you of “feeling worse than before.” 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 D with your assignment.

*Please note that the SRN would also document at the end of the shift, however it is not required for this assignment*

Final Part of assignment

You should close your assignment with a conclusion

 You should allow 150-200 words. 

Assessment Item Three addresses unit learning outcomes one, two and three.

1. Apply the principles from the nursing process to deliver evidenced based, person centred nursing care to individuals and families at novice level.

2. Develop an awareness of cultural, legal and ethical principles required when interacting with individuals, families and other members of the multidisciplinary health care team to facilitate positive health outcomes.

3. Relate the significance of the Nursing Midwifery Board of Australia (NMBA) standards for practice and specific NSQHS Standards (2nd edition) to nursing practice.

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

The skill audit is non-graded as pass/fail. 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

Students can use their Berman (2017) Skills in Clinical Nursing text book as a guide when performing the skills. (Multiple attempts are permitted).

This is your practical assessment and you will be observed by your lecturer within the clinical learning space who will provide feedback and your result on the day.

Assessment Item 4 addresses unit learning outcomes one and three.

1. Apply the principles from the nursing process to deliver evidenced based, person centered nursing care to individuals and families at novice level.

3. Relate the significance of the Nursing Midwifery Board of Australia (NMBA) standards for practice and specific National Safety and Quality Health Service Standards to nursing practice.

This is the summative quiz relating to the content of the entire 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 Thursday of Week 13 (17th October). The quiz will be open for a 24-hour period, but once you commence the quiz you will have two hours to complete it. The quiz can be done online at home or on a university campus with the expectation that students will abide by 'exam like' conditions.

Online Quiz. The quiz has 120 questions that come from a bank of questions. Students will be allowed two hours to complete the quiz online, but it will be open for 24 hours to allow access at any time during that 24-hour period.

The quiz contains questions from the entire 12 weeks of the unit, or 8 modules of work.

Students will receive a mark out of 120 for the quiz once the quiz has closed and will only see their mark out of 120 as would be the case in an exam.