CQUniversity Unit Profile
NURS20170 Patient Deterioration in the Clinical Setting
Patient Deterioration in the Clinical Setting
All details in this unit profile for NURS20170 have been officially approved by CQUniversity and represent a learning partnership between the University and you (our student).
The information will not be changed unless absolutely necessary and any change will be clearly indicated by an approved correction included in the profile.
General Information

Overview

This unit examines clinical assessment and diagnostic reasoning to recognise and respond to a patient's deteriorating condition with appropriate and timely actions. This unit will enhance your knowledge of serious adverse events such as unexpected death and cardiac arrest which often follow observable deterioration in the patient’s condition. You will develop knowledge and skills in the early identification of deterioration, the initiation of prompt and effective action to minimise serious consequences, improve outcomes and lessen the level of intervention required to stabilise patients. The unit will focus on the underlying pathology of the patient's deteriorating condition and the interpretation of clinical manifestations to implement safe and effective nursing care.

Details

Career Level: Postgraduate
Unit Level: Level 8
Credit Points: 6
Student Contribution Band: 7
Fraction of Full-Time Student Load: 0.125

Pre-requisites or Co-requisites

Students must be enrolled in CL22 Master of Clinical Nursing or CL16 Graduate Certificate in Clinical Nursing to undertake this unit.

Important note: Students enrolled in a subsequent unit who failed their pre-requisite unit, should drop the subsequent unit before the census date or within 10 working days of Fail grade notification. Students who do not drop the unit in this timeframe cannot later drop the unit without academic and financial liability. See details in the Assessment Policy and Procedure (Higher Education Coursework).

Offerings For Term 2 - 2020

Online

Attendance Requirements

All on-campus students are expected to attend scheduled classes – in some units, these classes are identified as a mandatory (pass/fail) component and attendance is compulsory. International students, on a student visa, must maintain a full time study load and meet both attendance and academic progress requirements in each study period (satisfactory attendance for International students is defined as maintaining at least an 80% attendance record).

Class and Assessment Overview

Recommended Student Time Commitment

Each 6-credit Postgraduate unit at CQUniversity requires an overall time commitment of an average of 12.5 hours of study per week, making a total of 150 hours for the unit.

Class Timetable

Bundaberg, Cairns, Emerald, Gladstone, Mackay, Rockhampton, Townsville
Adelaide, Brisbane, Melbourne, Perth, Sydney

Assessment Overview

1. Practical Assessment
Weighting: Pass/Fail
2. Presentation
Weighting: Pass/Fail

Assessment Grading

This is a pass/fail (non-graded) unit. To pass the unit, you must pass all of the individual assessment tasks shown in the table above.

Previous Student Feedback

Feedback, Recommendations and Responses

Every unit is reviewed for enhancement each year. At the most recent review, the following staff and student feedback items were identified and recommendations were made.

Feedback from Email and discussion

Feedback

Request for more contact with Unit Coordinator

Recommendation

Regular (fortnightly) Zoom sessions to run in Term 2 2019. Regular (fortnightly) discussion posting by Unit Coordinator Continue visits to partnered Hospital & Health Services

Feedback from Moodle site, email and discussions at Hospital & Health Services.

Feedback

Question over assessment tasks due dates.

Recommendation

Clarification of due dates with student and partners to minimise confusion via Zoom, the discussion board, and email.

Unit Learning Outcomes
On successful completion of this unit, you will be able to:
  1. Explain clinical parameters that indicate a patient is deteriorating
  2. Monitor and interpret physiological and psychosocial data to assess a patient's clinical deterioration
  3. Communicate effectively with health team and family members to ensure the accurate transfer and escalation of critical information
  4. Initiate interventions based on diagnostic results of clinical assessment tools and evaluate your nursing actions
  5. Critically examine everyday nursing practices and the ready use of tools related to the deteriorating patient.

NA

Alignment of Learning Outcomes, Assessment and Graduate Attributes
N/A Level
Introductory Level
Intermediate Level
Graduate Level
Professional Level
Advanced Level

Alignment of Assessment Tasks to Learning Outcomes

Assessment Tasks Learning Outcomes
1 2 3 4 5
1 - Practical Assessment - 0%
2 - Presentation - 0%

Alignment of Graduate Attributes to Learning Outcomes

Graduate Attributes Learning Outcomes
1 2 3 4 5
1 - Knowledge
2 - Communication
3 - Cognitive, technical and creative skills
4 - Research
5 - Self-management
6 - Ethical and Professional Responsibility
7 - Leadership

Alignment of Assessment Tasks to Graduate Attributes

Assessment Tasks Graduate Attributes
1 2 3 4 5 6 7
1 - Practical Assessment - 0%
2 - Presentation - 0%
Textbooks and Resources

Textbooks

There are no required textbooks.

IT Resources

You will need access to the following IT resources:
  • CQUniversity Student Email
  • Internet
  • Unit Website (Moodle)
  • CQUniversity library literature search tools
  • CQUniversity Library website
  • CQUniversity Library Nursing Resources
Referencing Style

All submissions for this unit must use the referencing style: American Psychological Association 7th Edition (APA 7th edition)

For further information, see the Assessment Tasks.

Teaching Contacts
Julie Shaw Unit Coordinator
j.m.shaw@cqu.edu.au
Schedule
Week 1 - Module 1 - Introduction to the unit and the deteriorating patient Begin Date: 13 Jul 2020

Module/Topic

Introduction to the Unit. 

Concepts related to clinical judgement and the deteriorating patient.  

Chapter

Exploration of the concept of clinical judgement

Clinical reasoning cycle

Failure to rescue

Early signs of patient deterioration



Events and Submissions/Topic

Readings

Activities

Zoom: Introduction to Unit and Moodle site

Week 2 - Module 1 - Considering the deteriorating patient Begin Date: 20 Jul 2020

Module/Topic

Research related to the deteriorating patient.

Observations as data.

Chapter

Sourcing and exploration of literature related to deteriorating patient.

Relationship of literature to day-to-day nursing practices.

Local data collection related to physiological observations.

Events and Submissions/Topic

Readings

Activities

Week 3 - Module 2 - Monitoring and interpretation of physiological data Begin Date: 27 Jul 2020

Module/Topic

Physiological observations pertinent to the deteriorating patient.

Detailed examination of various observations.    


Chapter

Physiological observations that could identify a patient as deteriorating or at risk of deterioration.

Investigation and research relating to respiration rate and pulse. measurements.

Events and Submissions/Topic

Readings

Activities

Zoom: Modules 1 & 2.

Week 4 - Module 2 - Monitoring and interpretation of physiological data Begin Date: 03 Aug 2020

Module/Topic

Physiological observations pertinent to the deteriorating patient.

Detailed examination of various observations.

Chapter

Physiological observations that could identify a patient as deteriorating or at risk of deterioration.

Investigation and research relating to temperature and blood pressure measurements. 

Events and Submissions/Topic

Readings

Activities

Week 5 - Module 3 - Monitoring and interpretation of psycho-social data Begin Date: 10 Aug 2020

Module/Topic

Family centred care (FCC) and the deteriorating patient.

Application of principles of FCC in critical situations.

Chapter

Exploration of the principles of Family Centred Care.

Families as legitimate partners and recipients in the delivery of nursing care.


Events and Submissions/Topic

Readings

Activities

Zoom: Module 3.

Vacation Week Begin Date: 17 Aug 2020

Module/Topic


Chapter


Events and Submissions/Topic

Week 6 - Module 3 - Monitoring and interpretation of psycho-social data Begin Date: 24 Aug 2020

Module/Topic

Interruption and distraction in the clinical setting.

Situational awareness. 

Contribution of these concerns to the deteriorating patient.    

Chapter

Investigation of the concepts relating to interruption, distraction and situational awareness.

Application of principles to prevention of deterioration in clinical settings.    

Events and Submissions/Topic

Readings

Activities

Assessment Task 1 - Practical Assessment - Patient Deterioration in the Clinical Setting.

The due date for this assessment will be coordinated by the partnered Graduate Program Coordinator and is commonly held in conjunction with the student's local "study day". The due date for final completion is TBA.

Week 7 - Module 4 - Communicating effectively in situations related to the deteriorating patient Begin Date: 31 Aug 2020

Module/Topic

Effective clinical communication for prevention of deterioration.

Practice principles and their application in the clinical setting.    

    

Chapter

Clinical communication strategies, issues and concerns.

Clinical communication as a strategy to detect or prevent patient deterioration.

Events and Submissions/Topic

Readings

Activities

Zoom: Module 4.

Week 8 - Module 4 - Communicating effectively in situations related to the deteriorating patient Begin Date: 07 Sep 2020

Module/Topic

Clinical communication in critical situations

Application of principles in practice.

Chapter

Communication principles during a clinical deterioration situation.

Examples from the field.


Events and Submissions/Topic

Readings

Activities

Week 9 - Module 5 - Initiating and evaluating nursing actions based on clinical assessment findings Begin Date: 14 Sep 2020

Module/Topic

Advanced clinical decision making.

The initiation of nursing actions based on advanced clinical decisions.


Chapter

Information support in advanced clinical decision making.

Nursing care analysis.

Events and Submissions/Topic

Readings

Activities

Zoom: Module 5.

Week 10 - Module 5 - Initiating and evaluating nursing actions based on clinical assessment findings Begin Date: 21 Sep 2020

Module/Topic

Advanced clinical decisions in review.

The evaluation of nursing actions based on advanced clinical decisions.

Chapter

Complexity, time-pressures and evaluation. 

Evaluation and new learning.


Events and Submissions/Topic

Readings

Activities

Week 11 - Module 6 - Critical examination of everyday nursing practices relating to the deteriorating patient Begin Date: 28 Sep 2020

Module/Topic

Critical analysis on the run.

Systems and strategies for critical analysis.

Chapter

Critiquing complexity.

Speed and safety in the clinical environment.

Events and Submissions/Topic

Readings

Activities

Zoom: Module 6.

Week 12 - Module - 6 - Critical examination of everyday nursing practices relating to the deteriorating patient Begin Date: 05 Oct 2020

Module/Topic

The invisibility of everyday nursing practices.

Unmasking and legitimating the invisible.

Chapter

Say little, do much.

An examination of cultural influences on nursing practice.

Events and Submissions/Topic

Readings

Activities

Review/Exam Week Begin Date: 12 Oct 2020

Module/Topic


Chapter


Events and Submissions/Topic

Assessment 1 & 2 are coordinated by the Graduate Coordinator at the health setting and are to be completed by Friday 30th October, 2020.

Exam Week Begin Date: 19 Oct 2020

Module/Topic


Chapter


Events and Submissions/Topic


Term Specific Information

All assessments are attended at your employing institution and are coordinated by your Graduate Program Coordinator.

Assessment Tasks

1 Practical Assessment

Assessment Title
Practical assessment of the simulated deteriorating patient

Task Description

Due Date: Negotiated in your local clinical area.                   Weighting: Pass/Fail unit.

This assessment addresses the following Unit Learning Outcomes:

1. Explain clinical parameters that indicate a patient is deteriorating

2. Monitor and interpret physiological and psycho-social data to assess a patient's clinical deterioration

3. Communicate effectively with health team and family members to ensure the accurate transfer and escalation of critical information

Practical Assessment Explained

Serious adverse advents such as unexpected death and cardiac arrest may follow observable deterioration in a patient’s condition.

This clinical assessment evaluates your knowledge and skills in the early identification of a patient's deteriorating condition and the initiation of prompt and effective action to minimise serious consequences, improve outcomes and lessen the level of intervention required to stabilise patients. The assessment will also assess your knowledge of the pathology of the patient's deteriorating condition, your ability to interpret clinical manifestations and effectively communicate these changes in health to team members including the patient, plus family members.

Task Description

You are required to demonstrate the safe care of a deteriorating patient in a clinical simulation setting. This assessment is undertaken at three skill stations (this structure may vary across different Hospital & Health Services).

You will be required to rotate between three skill stations. At each station a scenario relating to a deteriorating patient will be presented. During the first stage you will have the opportunity to practice skills to recognise and respond to a deteriorating patient. During the second stage, you will be assessed on your ability to safely perform these skills: These skills include:

  • initial nursing management
  • verbalising a targeted systematic assessment approach (look, listen and feel ABCDEFG) [this worksheet is available on the Moodle site]
  • recording vital signs
  • verbalising escalation concerns using ISBAR
  • managing basic airway manoeuvres, adjuncts and oxygen therapy delivery devices
  • identifying further clinical risk factors and additional investigations that may be required
  • selecting and inserting the correct naso/oropharyngeal airway
  • demonstrating chin lift, head tilt and manual ventilation techniques
  • demonstrating and instructing on the use of nasal prongs, Hudson and non-rebreather masks, and the HFNP Air Viva

Task Instructions

Step 1. Familiarise yourself with the relevant policies, procedures and legislation available on the unit Moodle site.

Step 2. Familiarise yourself with Standard 8, Recognising and responding to acute deterioration standard (The Australian Commission on Safety and Quality in Health Care, [ACSQH] 2017). Some health care providers are using the first edition of standards so you may also need to review Standard 9, Recognising and responding to clinical deterioration in healthcare (ACSQH, 2012).

Step 3. In Stage 1 of the simulation, practice your skills in recognising and responding to deteriorating patients as you rotate through the three skill stations.

Step 4. In Stage 2 of the simulation, demonstrate your ability to recognise and respond to the deteriorating patient. You will need to demonstrate:

  • initial nursing management
  • verbalising a targeted systematic assessment approach (look, listen and feel ABCDEFG) [this worksheet is available on the Moodle site]
  • recording vital signs
  • verbalising escalation concerns using ISBAR
  • managing basic airway manoeuvres, adjuncts and oxygen therapy delivery devices
  • identifying further clinical risk factors and additional investigations that may be required
  • selecting and inserting the correct naso/oropharyngeal airway
  • demonstrating chin lift, head tilt and manual ventilation techniques
  • demonstrating and instructing on the use of nasal prongs, Hudson and non-rebreather masks, and the HFNP Air Viva

Return Date to Students: Return information will be given at your local health service.


Assessment Due Date

You will negotiate your due date at your local clinical setting


Return Date to Students

You will negotiate the return date at your local clinical setting


Weighting
Pass/Fail

Assessment Criteria

Student name: ­­­­­­­­­­­­__________________________

Students must pass each criterion in each skill/topic to be successful in this assessment

Students may have a second attempt if unsuccessful at the first attempt.

Skill / Topic Pass FAIL
  • Skill station: Patient deterioration
  • Demonstrate ability to use: look, listen and feel ABCDEFG  1. Otto Breath - respiratory distress and a modified chart   2. Ida Noe - acute confusion plus an irregular HR
  • Demonstrates an ability to escalate care of the deteriorating patient in a timely manner
  • Appropriately records vital signs provided on the QADDS chart including, graphs and correct scoring
  • Effectively and accurately describe the initial management  they instigated and outlines any concerns
  • ISBAR escalation is conducted by the participants
  • Clearly explains to family members changes in the patient's condition
  
  • Oxygen Therapy
  • Demonstrate application, advantages and disadvantages of nasal prongs, Hudson and non-rebreather masks
  • Explains flow rates and the precautions required in the administration of oxygen
  • Demonstrate the use of high flow nasal prongs (HFNP)
  • Basic Airway Management
  • Demonstrate airway manoeuvres, insertion/removal of devices and ventilation with bag-valve-mask (BVM)
  • Effectively demonstrate relevant basic airway management clinical skills
  • Knowledge of polices and guidelines
  • Identified deterioration points are justified, logical and aligned with the Registered Nurse Standards for Practice (2016), the Australian National Quality Safety Standards (2014), and/or other relevant legislation and policies.


Referencing Style

Submission
Offline

Submission Instructions
Assessment will be under taken in the clinical setting at a date and time set by the Graduate Program Coordinator where you work

Learning Outcomes Assessed
  • Explain clinical parameters that indicate a patient is deteriorating
  • Monitor and interpret physiological and psychosocial data to assess a patient's clinical deterioration
  • Communicate effectively with health team and family members to ensure the accurate transfer and escalation of critical information


Graduate Attributes
  • Knowledge
  • Communication
  • Cognitive, technical and creative skills
  • Self-management
  • Ethical and Professional Responsibility

2 Presentation

Assessment Title
Presentation

Task Description

Due Date: Set by your Graduate Program Coordinator at your place of employment

Weighting: Pass/Fail unit.

This assessment addresses the following learning outcomes:

    4. Initiate interventions based on diagnostic results of clinical assessment tools and evaluate your nursing actions

    5. Critically examine everyday nursing practices and the ready use of tools related to the deteriorating patient

Task description

You are required to undertake an oral presentation that discusses your participation, observations and interactions in a clinical simulated scenario of a deteriorating patient, in the simulation laboratory at your workplace. Your target audience for your presentation are your workplace colleagues, peers and nurse educators.

Task Instructions    

Step 1. Observe clinical simulated scenarios in the simulation laboratory at your workplace. These scenarios focus on the care of the deteriorating patient. The escalation of care required to meet the needs of the patient; the type of interventions required to ensure the best clinical outcomes for the patient; and the effective communication of the patient’s changing health status.

Step 2. During the simulations you will be provided with clinical information related to the patient. You are expected to assess the patient, record the vital signs, determine and initiate nursing management and decide when to escalate interventions using ISBAR. This information will be recorded on an assessment worksheet [found on the Moodle site].

Step 3. Present your findings to the group following each clinical simulation. Some important points to consider for presentation while you are participating in, and observing the simulation include:

  • Critical thinking and problem solving skills required in addressing the patient deterioration
  • Accurate recording of vital signs on the QADDS chart
  • How effective escalation using ISBAR was demonstrated
  • Effective team work and communication including the use of clinically appropriate language in the communication of key signs/symptoms and the decision to escalate
  • Effective communication including the use of appropriate language when communicating with the patient and/or family members
  • The role of the registered nurse in the deteriorating patient simulation

Return Date to Students: Return information will be given at your local health service.


Assessment Due Date

Presentation due dates will be negotiated at the local clinical setting


Return Date to Students

Provided by your Graduate Coordinator at your employing health service.


Weighting
Pass/Fail

Assessment Criteria

Student name: ­­­­­­­­­­­­__________________________

Students must pass each criterion in each skill/topic to be successful in this assessment

Students may have a second attempt if unsuccessful at the first attempt.

Skill / Topic Content covered PASS FAIL
Patient Deterioration

Debrief after each scenario and provides constructive feedback on:

  • Clinical decision making
  • Recognising deterioration using ABCDEFG
  • Team work and communication
  • ISBAR escalation
  • Role clarification
  • Communicates effectively, to patient and/or family members, the change in patient’s condition



Demonstrates cognitive and technical skills:

  • Demonstrates clear thinking and technical competence
  • Signs and symptoms identified
  • Identifies ISBAR escalation
  • Identifies the role of the registered nurse
  • Communicates effectively to patient and/or family members




Does not demonstrate cognitive and technical skills:

  • Does not demonstrate clear thinking and technical competence
  • Signs and symptoms are not clearly identified
  • Does not accurately identify ISBAR escalation
  • Is unclear in identifying the role of the registered nurse
  • Does not communicate effectively with patient and/or family members
Debrief

Following each scenario, the teams are asked to provide constructive feedback on:

  • Clinical decision making
  • Team work, leadership, role
  • Escalation using ISBAR
  • Communication with patient/family member/s





  • Presents up to date and accurate knowledge
  • Demonstrates clinical decision making
  • Discusses teamwork and leadership adequately
  • Escalates care using ISBAR
  • Communicates effectively with patient and/or family member




  • Does not present up to date and accurate knowledge
  • Does not demonstrate clear clinical decision making
  • Does not adequately discusses teamwork and leadership
  • Does not discuss reasons to escalate care using ISBAR
  • Does not communicate effectively with patient and/or family member/s


Presentation
  • Oral style: Uses vocabulary structures and forms to appropriately address audience
  • Incorporates appropriate headings (teamwork, leadership, reasons to escalate care).

Communication

  • Communicates clearly and accurately
  • Incorporates appropriate heading



Communication

  • Does not communicate clearly and accurately.
  • Does not address appropriate heading (teamwork, leadership, reasons to escalate care)

PASS/FAIL                 Assessor Name____________________________ Signature _____________________________________ Date_____________


Referencing Style

Submission
Offline

Submission Instructions
Presentations will be undertaken at the local clinical setting

Learning Outcomes Assessed
  • Initiate interventions based on diagnostic results of clinical assessment tools and evaluate your nursing actions
  • Critically examine everyday nursing practices and the ready use of tools related to the deteriorating patient.


Graduate Attributes
  • Knowledge
  • Communication
  • Cognitive, technical and creative skills
  • Research
  • Self-management
  • Ethical and Professional Responsibility

Academic Integrity Statement

As a CQUniversity student you are expected to act honestly in all aspects of your academic work.

Any assessable work undertaken or submitted for review or assessment must be your own work. Assessable work is any type of work you do to meet the assessment requirements in the unit, including draft work submitted for review and feedback and final work to be assessed.

When you use the ideas, words or data of others in your assessment, you must thoroughly and clearly acknowledge the source of this information by using the correct referencing style for your unit. Using others’ work without proper acknowledgement may be considered a form of intellectual dishonesty.

Participating honestly, respectfully, responsibly, and fairly in your university study ensures the CQUniversity qualification you earn will be valued as a true indication of your individual academic achievement and will continue to receive the respect and recognition it deserves.

As a student, you are responsible for reading and following CQUniversity’s policies, including the Student Academic Integrity Policy and Procedure. This policy sets out CQUniversity’s expectations of you to act with integrity, examples of academic integrity breaches to avoid, the processes used to address alleged breaches of academic integrity, and potential penalties.

What is a breach of academic integrity?

A breach of academic integrity includes but is not limited to plagiarism, self-plagiarism, collusion, cheating, contract cheating, and academic misconduct. The Student Academic Integrity Policy and Procedure defines what these terms mean and gives examples.

Why is academic integrity important?

A breach of academic integrity may result in one or more penalties, including suspension or even expulsion from the University. It can also have negative implications for student visas and future enrolment at CQUniversity or elsewhere. Students who engage in contract cheating also risk being blackmailed by contract cheating services.

Where can I get assistance?

For academic advice and guidance, the Academic Learning Centre (ALC) can support you in becoming confident in completing assessments with integrity and of high standard.

What can you do to act with integrity?