Due Date: Wednesday, 10th April 2019. 11.45pm (Week 5)

Word Count: 2500 – 3000 words (Please see word count for each Section for clarification)

NB: The word count is considered from the first word of the introduction to the last word of the conclusion. It includes in-text references and direct quotations. It excludes the cover page, contents page, reference list and appendices (if applicable).

Weight: 50%

Learning Outcomes:

1. Consider legal and ethical frameworks and evidence based practice principles to explore the complexity of person centred nursing care across the lifespan in the sub-acute and community settings.

2. Discuss a lifespan approach to local, national and international chronic disease patterns and preventative measures.

3. Explore the safe use of technology to facilitate person centred nursing care across the lifespan within the sub-acute and community settings.

5. Integrate cultural competence to develop person centred nursing interventions across the lifespan including discharge planning where relevant to the sub-acute and community setting.

Instructions:

You will research the subacute and community management of a person with a diagnosis of Huntington’s disease. Your assessment submission will incorporate three distinct sections:

1. disease description,

2. an annotated bibliography

3. a reflection on your learning.

Please be aware, this assessment is not an essay and as such, there should not be an introduction or conclusion.

Section 1 – The Disease: 500 words maximum (you will need to write succinctly)

You will describe the diagnosis of Huntington’s disease. You should briefly explain the pathophysiology, and the clinical manifestations, some significant statistics and treatment options. Your statistics should present mortality and morbidity rates, variations between male vs female diagnosis, age of diagnosis, and age of survival within Australia, and comparing these to the International setting. Again, keep it brief and to the point.

Section 2 – Annotated Bibliography: 12 citations and 150 words (+/- 10%) for each citation

While researching your literature, you will need to keep in mind a few points of focus. Your research should show the different components of Huntington’s disease, as experienced by a person with the diagnosis.

Your research should include:

· Diagnosis

· General care/management across the Huntington’s disease stages

· End stage care including palliative care considerations

An annotated bibliography allows you to become acquainted with the material available on a given topic.

• An annotated bibliography starts with the citation, followed by a brief annotation.
• Each annotation should be concise. Do not write too much—remember, you are writing a summary, not an essay. Annotations should be no longer than one paragraph. As such, only mention significant and relevant details. This assessment has a requirement of 150 words (+/- 10%) per citation. Please, do not get too focussed on exact word counts. The importance should be on being succinct and to the point. This will be discussed further during the term in Assessment Support communications.
• As you are addressing one text at a time, do not cross-reference or use in-text citations (referencing) to support your annotation. The citation is not included in the word count.
• While you must consider the Australian focus, International articles should not be discounted. You may use these resources for Assessment 2, and International information can be used to support your discussion.
• You should write in full sentences and to academic standards of presentation as per the 2018 APA Referencing Guide.

§ As with a normal reference list, an annotated bibliography is arranged alphabetically as per the APA Referencing Style.

§ An exemplar is available on the Moodle site.

Section 3 – Reflection: 500 words maximum

Your reflection should incorporate what you have learned about community management of a patient with a diagnosis of Huntington’s disease from your research. You should follow Gibbs Reflective Cycle. You should include evidence-based practice principles. It is accepted you will write in the first person for the reflection section only. Be mindful to not allow this to lead to casual language and grammar.

General Information.

· You will only be required to reference sources for Section 1 – The Disease, and if you use any in your reflection. The reference list is on its own page at the end of your work. You are not required to recreate a reference list for your annotated bibliography.

· Please use headings for each section of your work. This means a contents page will be required in your work.

· Your sources for your annotated bibliography should be quality literature. Primary sources are preferable but not a requirement.

· Remember the three R’s for your sources. Recent, Reliable and Relevant.

· You should write in academic language and not in the first person other than your reflection. Be mindful of punctuation, grammar, spelling and sentence structure.

· All three sections must be formatted as per the 2018 APA Referencing Guide.

· Referencing must be APA Style as per the 2018 APA Referencing Guide.

· Please… do not hesitate to ask questions related to your assessment if you are unclear.

Marking Criteria NURS13134 - Assessment One

Student name: Student Number:

Section 1 – The Disease 15%

Section 2 – Annotated Bibliography 75%

Section 3 – Reflection 10%

Due Date: Monday, 27^th of May, 2019. 11.45pm (Week 11)

Word Count: Patient Progress Notes (no word count - see below) Academic Paragraphs - 2000 words (+/- 10%)

NB: The word count is considered from the first word of the introduction to the last word of the conclusion. It includes in-text references and direct quotations. It excludes the cover page, contents page, reference list and appendices (if applicable).

Weight: 50%

Learning Outcomes:

1. Consider legal and ethical frameworks and evidence based practice principles to explore the complexity of person centred nursing care across the lifespan in the sub-acute and community settings.

2. Discuss a lifespan approach to local, national and international chronic disease patterns and preventative measures.

3. Explore the safe use of technology to facilitate person centred nursing care across the lifespan within the sub-acute and community settings.

4. Appraise communication processes that enable continuity of care, person safety and quality within the sub-acute and community setting.

5. Integrate cultural competence to develop person centred nursing interventions across the lifespan including discharge planning where relevant to the sub-acute and community setting.

Instructions:

You will be introduced to Alejandro Rodriguez at various points across his disease progression in the form of case study notes and patient/family conversations.

There are three (3) segments to the assessment. For each segment, you will write patient notes using the SOAPIE acronym, based on the case study notes and an academic paragraph as evidence of best practice, critical thinking and justification of information in the patient notes.

For the purposes of this assessment, you are a student Registered Nurse on placement in a Community Nursing Service. Referred patients attend your clinic for their first appointment and assessment.

Segment 1 - Introducing Alejandro – Early Stage – 1^st February, 20XX

Height: 170cm

Weight: 87kg

Past medical history:

· Osteoarthritis, managed with heat packs and paracetamol PRN

· Hypertension, well managed with perindopril arginine 5mg nocte

As you attend to Al’s vital signs and welcome him and his family, you notice the following:

· He tends to grimace every now and then as he speaks and he has some slight twitching in his fingers.

Hello. My name is Alejandro Diego Rodriguez. Bit of a mouthful I know. Just call me Al. My people come from Venezuela in South America, even though I was born here in Australia. I am 48 years old. I am married to my beautiful wife, Jane and we have two kids. Melanie, our daughter is married to Bevan and they have a 4yo son, Toby. Then David, our son. I have a couple of pictures here. These were taken at a family BBQ last year. David is taking the pictures so the first one is of Jane, Melanie, Bevan, with little Toby and me in the middle. Then David in one of his famous “selfies”.

So, a little while ago, I started to get a bit worried that I was forgetting things and I was struggling to concentrate at times. I would stumble and was getting clumsy. It was making me feel very depressed and Jane said I was very moody as well.

Jane took me to our doctor and she asked me all these questions about my family. I said my mother had died some time ago and she had dementia. The doctor then asked me about my aunts, uncles, and grandparents. She wanted to know if any of them had dementia. Well, a few of them had in fact. This was clearly the wrong answer as she then sent me for a whole bunch of tests and I had to go for an MRI on my brain. Well, the final thing is, I have Huntington’s disease. It’s only early at the moment. I know that I do have mood swings sometimes, but so do lots of people.

Jane asks if she can have a moment of your time as David takes Al to the car.

Jane appears stressed and anxious. She is not making eye contact and is fidgeting with her wedding bands. You offer her a glass of water and ask her what she would like to discuss. Jane bursts into tears, then composes herself and begins to tell her story.

He has more than mood swings. He can be very aggressive and angry and accuses us of everything from hiding his things to me having an affair! He is very depressed, and he says things like we would all be better off if he was dead, but then tells me later that he didn’t say those things! It’s like he is slowly changing into someone I don’t know anymore. He goes out to his shed but he isn’t building things anymore. It is a mess out there and not at all how he used to keep it. Everything had a place and everything in its place. He has about 1000 half-finished projects. It is as if he can’t finish them.

Segment 2 – Intermediate Stage Huntington’s Disease – 1^st June, 20XX

You are a student Registered Nurse on a Community Nursing placement. You are on a home visit to Al and his family.

Height: 170cm

Weight: 79kg

Past medical history:

· Osteoarthritis, managed with heat packs and regular Panadol Osteo

· Hypertension, moderately managed with perindopril arginine 10mg nocte

When you arrive, Jane calls Al from the next room. He is somewhat argumentative about stopping what he is doing. Jane calls him again and he has an aggressive outburst. Jane apologises and states that he gets “stuck in the moment” sometimes and it can be difficult to redirect him.

Al makes his way into the room. His gait is very unsteady with marked chorea and dystonia.

As Al notices you in the room, he appears wary and not to recognise you. You introduce yourself and he reacts with, “Yes, I know who you are, I’m not senile!”

Al’s speech is slurred and hesitant.

Al is offered a drink by Jane and as he takes a sip, he gags and coughs for a short time. Jane states he is doing that more often now.

Al states, “I can’t swallow it properly, I think she is trying to kill me!”.

You ask Al about his most recent fall. He denies that he has ever fallen over and that you must all be talking about him and making things up behind his back.

He makes the sign of the cross to a picture of Mary on the wall. On checking Al’s notes, it is documented he is a practicing Catholic.

Al does not speak again for some time while you are in conversation with Jane.

After some time, Al blurts out, “You can go now, I need a nap”.

Jane looks embarrassed but assists Al to his room. On her return, she updates you on Al’s last medical appointment and medication changes. Jane is teary and appears anxious and distressed. She tells you, Al refuses to use the medical alert assist buzzer or forgets to wear it.

Segment 3 – Advanced/End Stage Huntington’s Disease 1^st December, 20XX

You are a student Registered Nurse on a Community Nursing placement. You are on a home visit to Al and his family.

Height: 170cm

Weight: 71kg

Past medical history:

· Osteoarthritis, the family no longer use heat packs. Jane states she took a phone call, forgot about the heat pack and as Al couldn’t feel it properly, he received a burn. It is now managed with products such as DEEP HEAT cream or Metsal cream.

· Hypertension, managed with perindopril arginine 10mg nocte

When you arrive, you are directed to the main living area where a hospital bed has been set up for Al. He does not acknowledge you or speak.

As you attend to Al’s vital signs and an assessment, you notice crackling (rales), and wheezing (rhonchi) in both lungs during auscultation. Rales and Rhonchi (Clicking on these links will take you to a website to hear the sounds. Best heard with headphones.)

Al is surrounded by his family, David, Melanie and Jane. Bevan is in the other room with Toby. Jane appears anxious and distressed as does Melanie who is consoling Jane. David is quiet, sitting in the corner and appears angry, his jaw is clenched, and he has his hands in fists.

Al is now receiving nutrition through a percutaneous endoscopic gastrostomy feeding tube (PEG).

Assessment requirements

For this assessment, you are to write patient notes, using the SOAPIE acronym, for all three segments of Al’s Huntington’s disease journey. You will find the Patient Progress Notes Template on the Moodle site under the Assessments Tab.

In addition, you will also write a paragraph for each of the three segments in a Word document as evidence of best practice and justification of information in the patient notes.

This means you will be submitting four documents. Three will be the Patient Progress Notes for each segment and the forth will be your written academic paragraphs, in one Word document.

Patient Progress Notes

Download the Patient Progress Notes template available on the Moodle site. Enter all information directly here – it is formatted to be able to type directly onto this document. Using the Patient Progress Notes Template, address each segment of Al’s Huntington’s disease journey as a new document. You must use the SOAPIE acronym to direct your notes.

You will write from the perspective of a Community Nurse student including consideration of scope of practice.

Where appropriate, consider the use of technology and/or cultural considerations and/or referral to other services.

You will not reference in the patient notes.

There is no word count for this component as the expectation is, as with any patient notes, be succinct, direct and to the point. You will not require more space than supplied on the Patient Progress Notes Template.

Academic Paragraphs

Each segment of Al’s Huntington’s disease journey will be addressed with a paragraph. Each paragraph should be 500 (+/- 10%) words. You will still write an introduction and a conclusion for this component. The introduction and conclusion word count is 250 (+/-10%) words each. You will use your research from Assessment One to justify your decisions in your progress notes. This will show evidence of best practice and your skills of critical thinking. You may be required to undertake further research.

You will format and reference as per the APA Referencing Guide, both in text and reference list.

General Information

· Write patient notes for each segment of Al’s Huntington’s disease journey. Do not reference. Write succinctly and to the point, using a new set of progress notes for each segment.

· Write a paragraph (500 words +/- 10%) for each segment for justification, evidence of best practice and critical thinking. This is to be in essay style, including an introduction and a conclusion. Do not use headings.

· Word Count - no word count for patient notes and 2000 words +/- 10% for the academic paragraphs.

· Referencing and formatting must be as per the APA Referencing Guide for the academic paragraphs.

Marking Criteria NURS13134 – Assessment Two

Patient Progress Notes

Academic Paragraphs