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 1 - 2021

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: 08 Mar 2021

Module/Topic

Welcome to the Unit

Self-directed Learning

Moodle site

Student Support

Something about the Unit.

  • clinical judgement
  • the deteriorating patient

Chapter

Check out the Moodle site and click on all the links.

Assessment?

How do I find the Library?

What is the Academic Learning Centre?

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion page and introduce yourself to your colleaguesby providing your name:

1. Name

2. What you are looking forward to as a Registered Nurse


Week 2 - Module 1 - Considering the deteriorating patient Begin Date: 15 Mar 2021

Module/Topic

Research related to the deteriorating patient.

  • exploration of literature
  • evidence and practice

Observations as data.

Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion. Identify the most difficult aspect that you have experienced when caring for a deteriorating patient.

Week 3 - Module 2 - Monitoring and interpretation of physiological data Begin Date: 22 Mar 2021

Module/Topic

Physiological observations pertinent to the deteriorating patient.

Detailed examination of various observations.  


Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion.

Detail what you have learnt about assessing physiological observations correctly.

Week 4 - Module 2 - Monitoring and interpretation of physiological data Begin Date: 29 Mar 2021

Module/Topic

Physiological observations pertinent to the deteriorating patient.

  • temperature
  • blood pressure

Detailed examination of various observations.

Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

Explain the impotance of temperature assessment of the older person.

Week 5 - Module 3 - Monitoring and interpretation of psycho-social data Begin Date: 05 Apr 2021

Module/Topic

Family centred care (FCC) and the deteriorating patient.

  • principles of FCC
  • Families as legitimate partners

Application of principles of FCC in critical situations.

Chapter

Readings and activities in Moodle



Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

Describe what you consider to be your family. Would all of these people be recognised as family.

Vacation Week Begin Date: 12 Apr 2021

Module/Topic


Chapter


Events and Submissions/Topic

Week 6 - Module 3 - Monitoring and interpretation of psycho-social data Begin Date: 19 Apr 2021

Module/Topic

Interruption and distraction in the clinical setting.

Situational awareness. 

Contribution of these concerns to the deteriorating patient.    

Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

Provide an example of being distracted in the clinical setting.

Week 7 - Module 4 - Communicating effectively in situations related to the deteriorating patient Begin Date: 26 Apr 2021

Module/Topic

Effective clinical communication for prevention of deterioration.

  • practice principles and their application in the clinical setting.
  • strategies, issues and concerns.


Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

What is effective communication?

Week 8 - Module 4 - Communicating effectively in situations related to the deteriorating patient Begin Date: 03 May 2021

Module/Topic

Clinical communication in critical situations

  • principles

Application of principles in practice

  • examples

Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm


Week 9 - Module 5 - Initiating and evaluating nursing actions based on clinical assessment findings Begin Date: 10 May 2021

Module/Topic

Advanced clinical decision making.

Nursing care analysis.

The initiation of nursing actions based on advanced clinical decisions.

Chapter

Readings and activities in Moodle


Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

What do you use to guide your clinical decison making?

Week 10 - Module 5 - Initiating and evaluating nursing actions based on clinical assessment findings Begin Date: 17 May 2021

Module/Topic

Advanced clinical decisions in review.

  • Complexity, time-pressures and evaluation.

The evaluation of nursing actions based on advanced clinical decisions.

  • Evaluation and new learning.

Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

Week 11 - Module 6 - Critical examination of everyday nursing practices relating to the deteriorating patient Begin Date: 24 May 2021

Module/Topic

Critical analysis on the run.

  • Speed and safety in the clinical environment.

Systems and strategies for critical analysis.

  • Critiquing complexity.

Chapter

Readings and activities in Moodle




Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

Any questions?

Week 12 - Module - 6 - Critical examination of everyday nursing practices relating to the deteriorating patient Begin Date: 31 May 2021

Module/Topic

The invisibility of everyday nursing practices.

Unmasking and legitimating the invisible.

An examination of cultural influences on nursing practice.

Say little, do much.

Chapter

Readings and activities in Moodle

Events and Submissions/Topic

Zoom - Monday 5pm

Activity – Access the General Discussion

Say goodbye.

Review/Exam Week Begin Date: 07 Jun 2021

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 11th June, 2021.


Practical assessment of the simulated deteriorating patient Due: Review/Exam Week Friday (11 June 2021) 5:00 pm AEST
Presentation Due: Review/Exam Week Friday (11 June 2021) 5:00 pm AEST
Exam Week Begin Date: 14 Jun 2021

Module/Topic


Chapter


Events and Submissions/Topic


Assessment Tasks

1 Practical Assessment

Assessment Title
Practical assessment of the simulated deteriorating patient

Task Description

Students undertaking this assessment will be either in:

  1. i) A Partnered Graduate Program

  1. ii) NOT in a Partnered Graduate Program

Type: Practical assessment

Due date:

  1. i) The Graduate Coordinator will advise students in a partnered Graduate Program of the due date.

  1. ii) Obtain a signed agreement from one of your unit nursing leaders (NUM, CNC, Nurse Educator) indicating that they will assess you in this task on an agreed due date. Provide the Unit Coordinator with a copy by the end of Week 2.

Weighting: PASS/FAIL

Unit Coordinator: Dr Julie Shaw

Learning Outcome 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.

Aim

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.

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 partnered 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 next 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 naso/oropharyngeal airway

  • demonstrating chin lift, head tilt and manual ventilation techniques

  • demonstrating and instructing on the use of nasal prongs, Hudson mask, 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).

Step 3. Stage 1- practice your skills in recognising and responding to deteriorating patients rotating through three skill stations.

Step 4. Stage 2 – demonstrate your ability to recognise and respond to the deteriorating patient including:

  • 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 device
  • identifying further clinical risk factors and additional investigations that may be required
  • selecting and inserting naso/oropharyngeal airway
  • demonstrating chin lift, head tilt and manual ventilation techniques
  • demonstrating and instructing on the use of nasal prongs, Hudson mask, non-rebreather masks and the HFNP Air Viva

Step 5. The assessors will forward the results of the assessment to the Unit coordinator.

Marking Criteria

Refer to the marking rubric below for more detail on how marks will be assigned.


Assessment Due Date

Review/Exam Week Friday (11 June 2021) 5:00 pm AEST

Assessment due date will be negotiated and undertaken in the clinical setting where you work


Return Date to Students

Exam Week Friday (18 June 2021)

Return of assessment will be negotiated and undertaken in the clinical setting where you work


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 
  • Demonstrates ability to escalate care of the deteriorating patient in a timely manner
  • Appropriately records vital signs provided on the deterioration observation document used in your facility
  • Verbalise initial management and outline concerns
  • ISBAR is used in escalation of treatment
  • Effectively communicates with patient and/or family members to explain change in patient’s condition
Oxygen Therapy
  • Demonstrate application, advantages and disadvantages of NP, HM, Non-rebreather
  • Explains the oxygen flow rates and precautions required
  • Demonstrate HFNP set up, uses and how to record setting.
Basic Airway Management
  • Demonstrate airway maneuvers, insertion/removal of devices and ventilating with BVM
  • Effectively demonstrate skills relevant to relevant clinical skills and tasks
Knowledge of polices and guidelines
  • Identified points of deterioration are justified and aligned with the Registered Nurse Standards for Practice (2016) and the Australian National Quality Safety Standards (2014) and/or other relevant legislation and policies.


Referencing Style

Submission
Offline

Submission Instructions
Assessment will be negotiated and undertaken in the clinical setting 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

Students undertaking this assessment will be either in:

  1. i) A Partnered Graduate Program

  1. ii) NOT in a Partnered Graduate Program

Type: Presentation

Due date:

  1. i) The Graduate Coordinator will advise students in a partnered Graduate Program of the due date.

  1. ii) Students not in a partnered Graduate Program must obtain a signed agreement from one of your unit nursing leaders (NUM, CNC, Nr Educator) indicating that they will assess you in this task on an agreed due date. Provide the Unit Coordinator with a copy by the end of Week 2

  2. .

Weighting: Pass/Fail

Length: No more than 10 minutes

Unit Coordinator: Dr Julie Shaw

Learning Outcome 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.

Aim

The aim of this assessment is to provide you with an opportunity to demonstrate your knowledge and understanding of using reflection to self-assess your clinical practice.

Instructions

You are providing an oral report on your participation in your simulation assessment.

Your target audience for your presentation may include your workplace colleagues, peers or unit nursing leaders.

Please follow the steps below to complete your assessment task:

Step 1. Access the Gibbs’ Reflective Model (1988) to reflect on your simulated patient deterioration activity – Assessment 1.

  • Gibbs’ steps to reflective practice are:
    • Description – what happened (situation/experience)?
    • Feelings – What are you thinking or feeling about this?
    • Evaluation – What was good and what was bad about the experience?
    • Analysis - What can you learn from this experience?
    • Conclusion – What could you have done differently?
    • Action – If you faced this situation again, how would you act differently (Gibbs, 1988)

Step 2. Structure your presentation in a manner that is logical, and the patient experience and your experience is presented systematically.

Step 3. Present your reflection in an objective manner to your audience that may include peers, educators and other unit nursing leaders.

Resources

Submission

No submission required as this assessment is undertaken in the workplace.

The assessor will forward the results of the assessment to the Unit coordinator.

Marking Criteria

Refer to the marking rubric on the Moodle site and below for more detail on how marks will be assigned.


Assessment Due Date

Review/Exam Week Friday (11 June 2021) 5:00 pm AEST

Presentation due dates will be negotiated at the local clinical setting


Return Date to Students

Review/Exam Week Friday (11 June 2021)

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?