Task - Part A

Due Date: Monday 8^th April, 1700 AEST

Weight: Pass/Fail (students must pass this assessment to complete the unit)

Length: 2700 words + uploaded charts

The word count is considered from the first word of the introduction to the last word of the conclusion. It excludes the cover page, abstract, contents page and reference list. It includes in-text references and direct quotations.

Referencing Style: APA 6^th Edition

Format:

· Size 12 font (Times New Roman or Arial)

· 1.5 spacing

· 2.54cm margins

· Page numbers, name and student number on each page

Learning Outcomes:

· Construct and adapt an evidence-informed and culturally safe nursing care plan based on patient assessment data with consideration of Aboriginal and Torres Strait Islander peoples and other culturally or linguistically diverse backgrounds

· Communicate with patients, families and healthcare teams, adhering to legal and professional standards. Identify processes to escalate parent/guardian health care concerns.

· Evaluate medications used in Australia and their uses in different client groups

· Prioritise and plan the safe administration of medications to a variety of patients

Overview

This assessment will provide you the opportunity to demonstrate your ability to analyse a complex situation, synthesise information and prioritise nursing care.

This assessment will also provide you the opportunity to demonstrate your ability to complete nursing documentation.

Task – Part A

Time: 1200hrs (midday)

Scenario: Justin Bloomfield

Sex: Male

Date of birth: 18 January 2015

Address: 24 Spring Street, Mt Surprise, QLD 4871.

Patient Identifier: 145769

Justin is a 4 year, 3-Month-old Aboriginal boy who was brought into the hospital emergency department by his grandmother Mary. Mary is Justin’s primary carer. You are a nurse caring for Justin. The hospital is located in a rural town.

Mary states that Justin has become more sleepy today and tearful. He has been off his food and fluid and has had two small vomits. She states that it might have something to do with his knee where he has a wound. Justin is not normally on any medication and she has not given Justin anything today.

Weight: 21kg

Height: 117cm

Justin is allergic to prawns and shellfish. He has no medical history of significance

Physical Assessment:

• His respiratory rate is 32 breaths per minute with mild respiratory distress.

• His oxygen saturations are 95% on room air.

• His temperature is 39.1 (taken aurally).

• His heart rate is 145 beats per minute and weak.

• His blood pressure is 85/56 mmHg.

• His capillary refill time (finger) is 2-3 seconds.

• His Blood Sugar Level is 6.7mmol.

• His pupils are a size 4 and are reactive to light.

• He follows directions.

· Skin is sweaty and clammy

He has not had his 4-year-old immunisations yet.

He can interact with you when you engage in conversation. Justin points to his right knee and states that it is “paining”. He is able to point to the frowny face on the pain scale.

Upon inspection you see a dressing heavy with exudate. Once the dressing is removed you find a deep ulcerated wound extending to the patella containing infective exudate, some granulated tissue and a wide margin of erythema extending 10cm around the wound.

Upon discussion with Mary you discover that Justin had a fall off his bike 10 days ago resulting in a deep “gash”. Initially she washed the wound in the shower and then put a gauze dressing on it. Because Justin got upset with getting his dressing changed she has changed the dressing only twice since the initial injury. She has noticed that the wound smells.

No medications have, as yet been ordered for Justin.

Step 1 (Clinical Reasoning) (1600 words)

Using resources you have come across in this unit, work through the eight (8) steps of the clinical reasoning cycle for this presentation. Please indicate what you will take into consideration when synthesising/evaluating this information and your nursing care considerations for each of those nursing actions.

You should use a separate heading for each of the Clinical Reasoning Cycle Steps.

Reference your sources of information (i.e., The Primary Care Clinical Manual).

Step 2 (Children’s Early Warning Tool/pain scale).

Complete the appropriate Children’s Early Warning Tool (CEWT) and any other clinical observation forms you feel are warranted with the above information.

Step 3 (Handover) (300 words maximum)

You decide to relay this information to the doctor on call by phone. Write out the ISOBAR handover that you will use to transfer this information and seek assistance.

Part B (Medication Safety) (400 words)

The doctor advises you that he is coming to review Justin and will be there in about 30 minutes.

Over the phone, the doctor orders the following:

IV Normal Saline fluid bolus of 20mls/kg

IV Flucloxicillin 25mg/kg, every 6 hours

Paracetamol 30mg/kg orally stat

Ibuprofen 10mg/kg orally stat

An experienced nursing colleague who has cannulation endorsement has placed a 20G cannula into Justin’s L) cubital Fossa:

Step 1. Document this in the appropriate section of the Paediatric Medication Chart and on the Fluid Chart (you may assume that another nurse has heard this order).

Step 2. Based on your nursing assessment, prioritise the order in which you would give these medications (provide a brief justification for your prioritisation).

Step 3. Calculate the appropriate medication dosages based on Justin’s weight. Show your working calculations in your submission.

Step 4. For IV medication using the Australian Injectables Drug Handbook (AIDH) and the Australian Medicines Handbook (AMH) and assuming that all medication strengths are available:

1. select the vial size and dose you would select (e.g., "XX drug comes in a 1g in a 5ml Vial, a 5g in a 10ml vial. For this situation I would choose .... because...”)

2. The volume and what type of fluid you would use for reconstitution.

3. The volume of the reconstitution required.

4. The volume you need to dilute this in.

5. The time needed to administer.

Please reference the AMH and AIDH in your submission if used.

PART C (Nursing Notes) (400 words or less)

Step 1. Write contemporaneous nursing notes, using SOAPIE format for this scenario adhering to the legal principles of documentation.

Step 2. Outline the advice you would give to a parent/guardian who feels their child is deteriorating and their health care concerns are not being acknowledged by the treating team.

UPLOAD SUGGESTIONS

1. Individually upload the CEWT (PDF) and Medication Chart (PDF).

2. Clinical Reasoning Cycle, Handover, Medication Safety and Nursing notes may be submitted as one document (docx or PDF). Ensure this document has a cover page. I suggest that each section begins on a new page with a clear heading.

During Residential School you will undertake a medication calculation quiz. This quiz will be done online using a computer program called Medsafe.

You may bring calculators and any mathematical formulae that you feel you may require.

The one-hour calculation quiz will comprise of 20 questions.

You must achieve 100% to pass this quiz. You have 3 attempts to achieve 100%

Throughout the Clinical Learning Environment tutorials (internal students) or Residential School (online students), you will undergo assessment activities. These activities will vary in complexity and will relate to patient scenarios you have been introduced to throughout the course.

You will undertake assessment following your review, practice and consolidation of the scenarios.

The assessment will be formative and summative in nature. This means that you are given the opportunity to improve throughout your learning.

This assessment tool has been developed under the domains of the Registered Nurse Standards for Practice:

1. Thinks critically and analyses nursing practice

2. Engages in therapeutic and professional relationships

3. Maintains the capability for practice

4. Comprehensively conducts assessments

5. Develops a plan for nursing practice

6. Provides safe, appropriate nursing practice

7. Evaluates outcomes to inform nursing practice

Each item is also linked to one or more of the 8 NSQHS standards.

The formative assessment item requires you, the learner, first to engage with these standards prior to undertaking the activity. Next you are required to conduct an evaluation of your performance. Consider what you have done well, what your knowledge/practice gaps are and what you will do in the coming days to bridge this gap. Next your lecturer will provide you with an evaluation of how well you have performed. Guidance will be given as to how your performance can be improved. It is important that you actively engage with this feedback prior to the summative assessment.

The summative assessment, like the formative, requires you to once again reflect on your performance, identify your strengths and knowledge/practice gaps. Your lecturer will provide you with a final evaluation and guidance regarding your suitability for clinical placement. If your competence in the domains is not yet satisfactory, you may either be commenced on a learning support plan or prevented from attending clinical placement. This is at the discretion of your lecturer and the Head of Course.

Formative Assessment (day 2 or 3)

Items marked with a * are mandatory requirements. Students must demonstrate competence in this area prior to clinical placement. Student who cannot demonstrate competence, may not be able to complete this Unit.

Additional Feedback:

Student Signature                                           Lecturer Signature                                              Date:

Summative Assessment (day 5/40 hours)

Items marked with a * are mandatory requirements. Students must demonstrate competence in this area prior to clinical placement. Student who cannot demonstrate competence, may not be able to complete this Unit.

Additional Feedback:

Student is able to commence clinical placement: Yes No

Clinical Placement Support Plan Initiated: Yes No

Student Signature                                                              Lecturer Signature                                                             Date:

Assessment 4

Length: 160 hours of Work Integrated Learning

Learning Outcomes Assessed:

1. Communicate with patients, families and healthcare teams, adhering to legal and professional standards.

2. Prioritise and plan the safe administration of medications to a variety of patients.

3. Apply the Nursing and Midwifery Board of Australia’s Registered Nurse Standards for Practice in the safe and effective care of individuals, families and the community whilst in the industry based learning environment.

Graduate Outcomes Assessed:

· Knowledge: Acquire and apply a body of knowledge and appropriate professional judgment relevant to a discipline.

· Communication: Communicate and interact with others and in culturally diverse contexts

· Ethical and Professional Responsibility: Demonstrate ethical, legal, social and civic responsibility.

· Cognitive, technical and creative skills: Investigate, analyse and synthesise complex information, problems and concepts.

· Research: Critically appraise outcomes and products of research for translation into the discipline.

· Leadership: Exercise initiative and responsibility, taking action and engaging others to make a positive difference as a global citizen.

· Self-management: Reflect on and critically evaluate one’s performance.

The Tasks

After Residential School, you will be ready to commence Work Integrated Learning. This is a 160-hour clinical placement, undertaken in one clinical setting. You have two assessment items which you must undertake while on placement.

Task A

Throughout your placement, you must keep a daily reflective journal. This is an opportunity for you to reflect on the nursing care you have delivered during the shift, work through the decisions you made and consider if you would act in the same way again, and link theory to practice. Please consider the NMBA Registered Nurse Standards for Practice and how they relate to your journal entries as you will need this in Task B.

Task B

Using your journal reflections as evidence of your practice, you will undertake a performance review with a clinical supervisor. The clinical supervisor will evaluate your ability to demonstrate how your ability to meet the NMBA Registered Nurse Standard for Practice. You will be assessed twice; formative assessment occurs at 80 hours and summative assessment occurs at 160 hours.

A comprehensive Work Integrated Learning guide is provided in Moodle.

Broadly, Work Integrated Learning is marked according to the Australian Nursing Standards Assessment Tool (ANSAT).

You must achieve a score of 3 or more in each domain of the ANSAT.