Aim

The aim of this clinical assessment is to evaluate 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 the patient. The assessment will also assess your knowledge of the pathology of a patient's deteriorating condition, your ability to interpret clinical manifestations and effectively communicate these changes in health to team members including the patient.

Instructions

You are required to demonstrate the safe care of a deteriorating patient in a simulated clinical setting. This assessment is undertaken at a skill station(s); this structure may vary across different Health Services. You may be required to rotate between skill stations. You will have the opportunity to practice the skills you will be assessed on prior to the clinical simulation.

You will then be assessed on your ability to explain and safely demonstrate the following skills:

• Initial nursing management
• Verbalising a targeted systematic assessment approach (look, listen and feel ABCDEFG) [this worksheet is available on the Moodle site], or you may use an alternative patient assessment framework, such as the primary/secondary assessment/survey, body systems or head-to-toe assessment
• Recording and verbalising 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 a 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, bag-valve-mask (BVM) and the high flow nasal oxygen therapy.

Please follow the steps below to complete your assessment task:

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

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). Standard 3 Personal Care and Clinical Care (The Aged Care Quality and Safety Standards) will also assist students undertaking this assessment from an aged care perspective.

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

Step 4. Stage 2 – demonstrate and explain your ability to recognise and safely 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] or you may use an alternative patient assessment framework, such as the primary/secondary assessment/survey, body systems or head-to-toe assessment
• Recording and verbalising 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 a 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, BVM and high flow nasal oxygen therapy.

Submission

Upload your completed rubric, signed by your Graduate Program Coordinator (for students enrolled in a partnered Graduate Program) or Assessor (for students not enrolled in a partnered Graduate Program) and yourself to the Assessment One portal in the Unit Moodle site. Please note that submission of fraudulent assessment results by a student will result in the notification to AHPRA of such occurrence.

Marking Criteria

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

To achieve a passing grade for this unit you are required to pass this assessment item.

If you do not receive a passing grade, you may be eligible for a re-attempt. A re-attempt is where you are given a second opportunity to demonstrate your achievement of one or more of the unit’s learning outcomes before you can progress to new learning or participate in subsequent learning activities. You may be given the opportunity to re-attempt an assessment but will only achieve a mark no greater than the minimum for a pass standard for the assessment. You must:

• have shown a reasonable attempt to complete the initial assessment task
• be granted a re-attempt by your Unit Lead/Coordinator
• make changes to the nominated assessment task which you have failed and resubmit the revised work for marking within seven consecutive days, no assessment extensions will be approved.

Please note: Only one opportunity for a re-attempt is allowed.

All students (partnered and non-partnered students) who are offered an assessment re-attempt are required to discuss assessment re-attempt preparation and due date with their Graduate Program Coordinator (for students enrolled in a partnered Graduate Program) or Assessor (for students not enrolled in a partnered Graduate Program).

Learning Outcomes Assessed

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.

NURS20170 Patient deterioration in the clinical setting – Assessment One Rubric.

Student name:                                                     Student number:

Please note that submission of fraudulent assessment results by a student will result in the notification to AHPRA of such occurrence.

Aim

The aim of this assessment is for you to demonstrate your knowledge, understanding and critical thinking using written reflection to self-assess your clinical practice undertaken in Assessment One.

Instructions

Provide a written reflection on your participation and clinical practice in your simulated clinical assessment (Assessment One). To complete this assessment, you are asked to access a validated reflection framework. Please follow the steps below to complete your assessment task.

Reflect on process and new learning. Using a validated reflection framework, reflect on one aspect of your simulated clinical assessment (Assessment One) you did well in or an aspect of practice you would like to develop further. Your written reflection could consider the following:

• Reflection on care coordination of the deteriorating patient: What went well or did not go well with your care coordination of the deteriorating patient? What impact could your care coordination have on your deteriorating patient’s outcome? What could you improve with future care coordination of the deteriorating patient? What strategies could you implement to improve future care coordination of the deteriorating patient?

OR

• Reflection on your communication (spoken and/or documented) with the multidisciplinary health care team: What was good or could be developed further about your communication with the multidisciplinary health care team about your deteriorating patient simulation? What potential consequences could ineffective communication have on your patient’s outcomes? How could your communication with the multidisciplinary health care team be improved to communicate the priorities of care more effectively for your deteriorating patient?

AND include

• Strategies you can undertake to optimise your deteriorating patient’s outcomes: What could you do differently in the future to escalate care coordination of your deteriorating patient?

Please follow the steps below to complete your assessment task:

1. Provide a brief introduction outlining the aim of your reflection assessment.
2. Provide a brief overview of your simulated clinical assessment (Assessment One) that your reflection will address.
3. Using a validated reflection framework, provide a critical, logical, objective and evidence-informed self-reflection on one aspect of care of the deteriorating patient from your simulated clinical assessment (Assessment One).
4. Identify one strategy to improve/develop in your care of the deteriorating patient from your simulated clinical assessment (Assessment One).
5. Provide a concise conclusion summarising the main learning from your reflection on your simulated clinical assessment (Assessment One).

An example reflection framework is Gibbs’ Reflective Model (1988) with the following steps to reflective practice:

• 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.

Other reflection frameworks you may use include Atkins and Murphy’s Model of Reflection (1993), Borton’s Framework for Reflection (1969), Rolfe’s Model of Reflection (2001), the 4/Rs Framework (Baine et al., 2002), or STAR reflection frameworks.

Literature and references

In this assessment use at least five contemporary references (5 years or less) to substantiate your discussion. You may use seminal scholarly literature where relevant. Suitable references include peer-reviewed journal articles as well as textbooks and credible websites. When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Grey literature sourced from the internet must be from reputable websites such as from government, university, healthcare organisations, or peak national bodies, for example, the Australian College of Nursing. Note, websites such as Stat Pearls, Life in the Fastlane, and Wikipedia are not suitable for this assessment task.

Requirements

• Have a cover page to your assignment that includes your name, student number, unit code, workplace, and in-text word count.
• Use a conventional and legible size 12 font, such as Times New Roman, with 2.0 line spacing and 2.54cm page margins (standard pre-set margin in Microsoft Word).
• Include page numbers on the top right side of each page in a header.
• You may write in the first-person perspective (I, my) when referring to your reflection, however, write in third person perspective when referring to the literature/evidence.
• Use formal academic language and essay structure.
• Start your reference list on a separate page to the body of your assignment.
• Use the seventh edition American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online CQU APA Referencing Style Guide.
• The word count is considered from the first word of the introduction to the last word of the conclusion. The word count excludes the reference list but includes in-text references and direct quotations. Avoid direct quotes as this reflects the knowledge of others and not your unique interpretation of the evidence.

Resources

• We recommend that you access a validated reflection framework, such as, Atkins and Murphy’s Model of Reflection (1993), Borton’s Framework for Reflection (1969), Rolfe’s Model of Reflection (2001), or STAR reflection frameworks.
• Decision-making framework (DMF) (NMBA, 2020).
• Nursing and Midwifery Board of Australia (NMBA) registered nurse standards for practice (2016).
• National Safety and Quality Health Service (NSQHS) Standards (2017) or Aged Care Quality Standards (2022).
• Patient Safety Competency Framework (PSCF) (Levett-Jones et al., 2017).
• We recommend that you access your discipline specific Nursing Resource Guide.
• We recommend you use EndNote to manage your citations and reference list. More information on how to use EndNote is available at the CQUniversity Library website.
• You may wish to submit a draft to Studiosity.
• You can use unit provided materials and other credible sources, e.g., journal articles, books to reference your argument. The quality and credibility of your sources are important.
• For information on academic communication please go to the Academic Learning Centre Moodle site. The Academic Communication section has many helpful resources including information for students with English as a second language.
• For information on using Zoom to present your assessment, please go to Zoom web conferencing.

Submission

Submit your assessment via the unit Moodle site in Microsoft Word format only.

Marking Criteria

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

To achieve a passing grade for this unit you are required to pass this assessment item. If you do not receive a passing grade, you may be eligible for a re-attempt. A re-attempt is where you are given a second opportunity to demonstrate your achievement of one or more of the unit’s learning outcomes before you can progress to new learning or participate in subsequent learning activities. You may be given the opportunity to re-attempt an assessment but will only achieve a mark no greater than the minimum for a pass standard for the assessment. You must:

• have shown a reasonable attempt to complete the initial assessment task
• be granted a re-attempt by your Unit Lead/Coordinator
• make changes to the nominated assessment task which you have failed and resubmit the revised work for marking within seven consecutive days, no assessment extensions will be approved.

Please note: Only one opportunity for a re-attempt is allowed.

Learning Outcomes Assessed

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

5. Analyse person-centerd care of the deteriorating patient through critical self-reflection of professional practice.

NURS20170 Patient deterioration in the clinical setting – Assessment Two Rubric

Student name:                                             Student number:

To achieve a pass in this assessment students must be successful in each of the 3 major criteria.

To be successful in each of the major criteria students must be successful in one half of the given minor criteria, i.e., 3/5; 3/6; 2/4