Aim
The aim of this assessment is for you to demonstrate your knowledge, understanding, and critical thinking about clinical deterioration using a case study.

Instructions
Read the case study and the associated clinical documentation. Please follow the steps below to write your academic essay and complete the assessment task.

1. Select one sign of clinical deterioration from the case study and explain why this may be occurring and why it is an indicator of deterioration. Using the case study provided and the associated clinical information, choose one sign of clinical deterioration, and using relevant up-to-date evidence, discuss why this is occurring and why this is an indicator of deterioration with specific reference to pathophysiology (approximately 200 words).
2. Critique the ISBAR script provided and identify two (2) areas that can be improved to facilitate safe patient transfer of care. Using relevant and contemporary evidence, provide a critical reflection, with a focus on how the communication can be improved to facilitate patient safety (approximately 300 words).
3. Identify one nurse-led intervention which could be initiated in the case study. Recommend a nurse-led intervention and support this with relevant contemporary evidence, making a connection to improved patient outcomes (approximately 200 words).
4. Reflect upon your learning from the case study. Identify one area within the case study in which person-centred care needs to be improved. Using relevant and contemporary literature, reflect upon the role of person-centred care and how it can improve communication and patient outcomes. Reflect upon how you will embed this learning into your future practice. Use the ‘what, so what, now what’ framework for this reflection (approximately 300 words).

Literature and references

In this assessment use at least eight contemporary references (5 years or less) sourced from the CQUniversity library to support 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, universities, healthcare organisations, or peak national bodies, for example, the Australian College of Nursing. Note, that websites such as Stat Pearls, Life in the Fastlane, and Wikipedia are not suitable for this assessment task. Lecture notes are not primary sources of evidence and should not be used in this assessment.

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, either Times New Roman or Arial font only, 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.
• Use formal academic and discipline-specific language.
• Write in the third-person perspective. When reflecting, please use the first-person perspective.
• Write in the third-person context, however you may use first-person context for the actions you undertook to complete your audit.
• All work submitted must be your own work.
• The use of generative artificial intelligence is permitted in this assessment and only as indicated in the GenAI Permissions Checklist specific to Assessment One in this unit.
• Use headings as per the above framework. An introduction and conclusion are not required.
• 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 excludes the reference list but includes in-text references and direct quotations, including paraphrasing and direct quotes. Please note, that direct quotes should be avoided in Post Graduate assessments.

Resources

• You can use unit-provided materials and other credible sources (e.g., journal articles, and books) to reference your argument. The quality and credibility of your sources are important. Please note, that lecture notes are not peer-reviewed primary sources of evidence.
• 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.
• You may like to manage your citations and reference list. Information on how to use academic referencing software (EndNote) is available at the CQUniversity Library website should you wish to learn how to use it.
• 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.
• You may wish to submit a draft to Studiosity.
• Submit at least one draft before the due date to review your Turnitin Similarity Score before uploading your final submission. Instructions are available here.

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 details 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 that 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

1. Interpret and explain physiological and psychosocial clinical parameters indicating patient deterioration.
2. Communicate effectively with interdisciplinary health teams, the patient and family to accurately transfer and escalate critical information.
3. Initiate and evaluate nursing interventions based on clinical assessment and diagnostic results to optimise patient outcomes.
4. Analyse a person-centred care approach to the deteriorating patient through critical self-reflection of professional practice.

 Case Study 

Jules is a 56-year-old gentleman who lives at home with his wife Kerrilyn. Jules is a retired police officer and now works in the community service field. Due to a previous Knee injury, Jules has a low exercise tolerance and lives a relatively sedentary lifestyle. Jules lives with Type II diabetes, arthritis, and hypercholesterolemia. Jules does not like taking medications, so is known to take his medication irregularly. He does like some of the side effects they give him. 

Jules was attending a family member's birthday party, enjoying some alcoholic beverages when he suddenly started to feel some tightness in his chest. After 30 mins, the tightness developed into a crushing feeling in his chest, radiating down the left arm, and he started to experience shortness of breath. It was at this point that his wife called the ambulance. 

The ambulance team arrived and assessed Jules, who reported his history. Jules indicated that he hadn’t taken his regular medication (Atorvastatin, Metformin, and Panadol Osteo) for three days. The ambulance team assessed Jules as follows: 

A-   Patent 

B-   Rapid respiratory rate 27 bpm, oxygen saturation 92% on room air. 

C-   Capillary refill 2 seconds, blood pressure 135/76 mmHg, heart rate 110 bpm.

D-   Alert and orientated GCS 15, blood glucose level 9.2mmol.

E-   Dressed appropriately for the weather, temperature 35.5 degrees Celsius. 

The ambulance team initiated Aspirin, completed an ECG which showed no acute changes, and transported Jules to the rural hospital. At the rural hospital, the following ISBAR handover was provided to hospital staff, away from Jules. 

I     “The patient here is Jules McIntyre. He’s a bit of a stubborn older man and isn’t the best communicator in the world".

S     “His wife Kerrilyn called us as Jules had an episode of chest pain, central crushing and he had some shortness of breath. When we arrived, he was sitting up and you could see he was uncomfortable.                    He also had five beers".

B     “He tells me he has a history of arthritis and high cholesterol and diabetes, but of course, he hasn’t taken his medications for three days. He doesn’t have any other medical history".

A     “His breathing is a little fast. Oxygen is a little on the lower side at 92%.  Anyway, we did an ECG, and I can’t see any acute changes. I gave him some Aspirin. I am not sure if he still has pain, but the                      pain settled in the ambulance".

R     “So, he’s here for the usual cardiac work-up. Oh, and his partner was hovering around out there, adding stress to the situation, so I told her there was no room for her, so she might come in". 

You accept the handover from the ambulance team?  and introduce yourself to Jules. Your assessment is completed as follows:

A    Patent, with a respiration rate of 31BPM. 

B    RR 30 bpm, oxygen saturation 90%.

C    Blood pressure 140/82 mmHg, blood glucose 10.5mmol, extremities cool to touch.

D    Alert and orientated, GCS 15, but only answering in short answers.

E    Temperature 36 degrees Celsius.

F     Heart Rate 120 BPM, Pain 7/10 ‘central heavy’ chest pain

Please use the clinical documentation available in the Moodle site to support this assessment and your answers. 

NURS20170 Patient Deterioration in the Clinical Setting

Assessment One – Written Case Study                                                                             Student name:

Aim
The aim of this clinical assessment is to demonstrate 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, and 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.

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 (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 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, bag-valve-mask (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 Two portal in the Unit Moodle site. Please note that the submission of fraudulent assessment results by a student will result in the notification to AHPRA of such an occurrence.

Marking Criteria
Refer to the marking rubric on the unit Moodle site for more details on how marks will be assigned. 

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

If you do not receive a pass 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. Interpret and explain physiological and psychosocial clinical parameters indicating patient deterioration.
2. Communicate effectively with interdisciplinary health teams, the patient and family to accurately transfer and escalate critical information.
3. Initiate and evaluate nursing interventions based on clinical assessment and diagnostic results to optimise patient outcomes.
4. Analyse a person-centred care approach to the deteriorating patient through critical self-reflection of professional practice.

NURS20170 Patient Deterioration in the Clinical Setting 

Assessment Two Practical Assessment

Student name:                                                                                                          Student number:                                         

Note – You must achieve a Pass in all criteria to pass this assessment.

Feedback:

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