Unit Code:    NURS20170 

Unit Title:      Patient Deterioration in the Clinical Setting

Assessment 1

Type:                                     Written Case Study 

Due Date:                             4pm (AEST), Wednesday 30th April 2025 (Week 7)

Extensions:                         Available as per policy 

Return Date:                        Wednesday 21st May 2025

Weighting:                            100% 

Length:                                 1000 words +/-10% (excluding reference list)

Unit Coordinator/s:            Dr Amy-Louise Byrne

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.

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

1.    Using the case study provided below, choose one sign of clinical deterioration. 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 in the case study and identify two (2) areas that can be improved to facilitate safe patient transfer of care. Using relevant and contemporary evidence, discuss how the communication can be improved to facilitate patient safety (approximately 300 words). 

3.    Recommend one nurse-led intervention and support this with relevant contemporary evidence, to improve 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).

Case Study:

Max is a 22-year-old man who lives at home with his parents. Max is an apprentice roofer, and he works full time. Max is an active person who plays for the local soccer team. He has no medical history, is a social drinker and occasional smoker. 

Max was at work on a hot day and was assisting a colleague to move sheeting to the roof via a ladder. Max misjudged the ladder step, lost his footing and fell onto the ground below, from a height of approximately 2 metres. Max landed on his shoulder and hit the left side of his head. Max was ‘dazed’ but reports that he did not lose consciousness. Max stayed as still as possible, and his work colleagues called for an ambulance.

The ambulance team assessed Max, who reported no history. Max was orientated to time and place, though was anxious about the situation and potentially missing work. The assessment from the ambulance was as follows:

A- Patent 

B- Rapid, respiratory rate 27 bpm, oxygen saturation 96% on room air 

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

D- Alert and orientated GCS 15, blood glucose level 4.2mmol

E- Dressed appropriately for the weather, temperature 37 degrees Celsius. 

The ambulance team applied a cervical collar as a precaution and transported Max to the regional hospital nearby. At the rural hospital, the following ISBAR handover was provided to hospital staff, away from Max. 

I   “The patient here is Max. He’s a young fella who was mucking about on the ladder and fell from a height of about 2 metres.”

S  “His work mates were all in a flap when we arrived, not managing the situation well. When we arrived, he was laying on the ground and you could see they were uncomfortable. I think he’s hurt their pride more than their head.

B  “Max doesn’t have any other medical history”. Max states that he didn’t lose consciousness; his work mates weren’t much help in that respect. Max states that he hit his shoulder first, the left side of head.”

A  “Breathing is a little fast. Oxygen is fine. GCS is 15, orientated to time and place, was more worried about going back to work than anything. All the other observations are written down if you want them.”

R  “So he’s here to be checked over, I guess. I think one of his work mates is here too. They’ve been asking me to call his mum, but I didn’t do that, didn’t have time.”

You accept handover from the ambulance service and introduce yourself to Max. Your assessment is completed as follows:

A  Patent, speaking in full sentences

B  RR 28 bpm, oxygen saturations 96% on room air.

C  Blood pressure 140/82 mmHg, blood glucose 4.6 mmol.

D  Alert and orientated, GCS 13, is confused to time and place and is asking when the next load of sheeting will arrive. 

E  Temperature 36 degrees Celsius.

F  Heart Rate 120 BPM, Pain 6/10 shoulder pain and a headache. 

Literature and references
In this assessment use at least 5 contemporary references (7 years old or less) to support your discussion. You may also 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 government, university, or peak national bodies: for example, the Australian College of Nursing, the Australian Association of Social Workers, Australian Bureau of Statistics, Australian Institute of Health and Welfare. Note, that websites such as StatPearls, 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. All resources, other than web pages and grey literature, must be sources from the CQUniversity library.

Requirements 
·         Use a cover page for your assignment that includes in the following order:

·         Student name

·         Student number

·         Unit code and name

·         Assessment type

·         Due date

·         In-text word count

·         Use of Gen AI: Gen AI agent…has been used for editing and proofreading this assessment (insert or delete as applicable).

·         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.

·         Indent the first line of each paragraph 1.27cm (standard pre-set indent in Microsoft Word).

·         An introduction and conclusion are not required for this assessment, instead, use headings to format your work.

·         All questions in the Instructions of this assessment must be attempted and clearly answered to pass this assessment task.

·         Write in the first-person perspective for your reflection, however, write in the third-person perspective when referring to the literature. 

·         Use formal academic, discipline specific, professional and inclusive language.

·         Use Microsoft Word English (Australia) spelling and grammar checker.

·         Paraphrase, summarise or quote information acknowledging the original source (referencing) to avoid plagiarism.

·         Follow academic writing conventions: spell out contractions in full; introduce abbreviations and acronyms; spell out numbers for zero through nine and use numerals for numbers 10 and above.

·         All work submitted must be your own work.

·         Start your reference list on a separate page to the body of your assessment.

·         Use the seventh edition American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online 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.

Resources
1.    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.

2.    We recommend that you access your discipline-specific Nursing Resource Guide Or the Social Work and Human Services Guide.

3.    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.

4.    For information on academic writing and referencing, please visit the Academic Learning Centre Moodle site. The Academic Communication section has many helpful resources, including information for students with English as a second language.

5.    You may wish to submit a draft to Studiosity.

6.    Submit at least one draft before the due date to review your Turnitin Similarity Score before making a final submission. Instructions are available here.

Academic Integrity
1.    You must abide by the principles of academic integrity (see Student Academic Integrity Policy and Procedure). Completion of this assessment with another party or sharing of responses is not permitted at any time.

2.    The use of any generative artificial intelligence is permitted for the following purposes:

·         Gen AI content is used to generate general structures.

·         Gen AI content editing. 

·         Checking spelling and grammar (for example, Grammarly).

If you use Gen AI to generate ideas, you are required to reference the Gen AI agent as per APA 7th guidelines. If you are using a Gen AI agent for content editing, please complete the declaration on the title page of your assessment. If Gen AI is not used, please delete this declaration. 

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

Late penalties of 5% per day of the available mark may be applied as per the Assessment Policy and Procedure (Higher Education Coursework). 

Contact TASAC if you experience technical issues submitting your assessment:

·         Phone toll-free 1300 666 620

·         Email tasac@cqu.edu.au 

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.

Minimum Pass Criteria
·         You must achieve a minimum grade of 50% to pass this assessment.

·         You must achieve a cumulative grade of at least 49.5% across all assessments to pass this unit.

·         In order to be eligible for a supplementary assessment, all assessment tasks must be reasonably attempted in this unit.

·         You must also complete and pass assessment two to pass this unit.

Unit Code:    NURS20170

Unit Title:      Patient Deterioration in the Clinical Setting

Assessment 2

Type:                                     Practical Assessment 

Due date:                              5 pm (AEST), Wednesday 4th June 2025 (Week 12) 

Extensions:                         Available as per policy 

Return date:                       See information below

Weighting:                         PASS/FAIL (0%). You must pass this assessment to pass  

                                           the unit.  

Unit Coordinators:             Dr Amy Byrne and Jill Baker

The completed Marking Rubric must be submitted to the assessment portal by 5pm (AEST) Wednesday 4th June (Week 12). 
 

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.

 
Aim
The aim of this clinical assessment is for you to demonstrate your knowledge and skills in the early identification of a patient's deteriorating condition and the initiation of prompt and effective actions 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 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.

·         Communicating 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).

Minimum Pass Criteria
·         You must achieve a Pass in all criteria to pass this assessment.

·         You must complete and pass assessment two to pass this unit.

·         You must achieve a cumulative grade of at least 49.5% across all assessments to pass this unit.

·         In order to be eligible for a supplementary assessment, all assessment tasks must be reasonably attempted in this unit.