NRSG370 Clinical Integration Assessment 3

NRSG370 - Clinical Integration - Speciality Practice

Assessment: Case Study Outline - Information For Students

Assessment 3: Case Study - North Sydney

The Clinical Reasoning Cycle

Students are expected to use the Clinical Reasoning Cycle (Levett-Jones, 2018) as a framework to plan and evaluate person-centred care. You are being asked to think through the case scenario and then discuss how data was collected and the type of data collected, identify problems and nursing issues, identify and state the objectives and discuss how care was provided in order to address the issues and evaluate the interventions carried out: (analyse and identify a nursing issues/problems/needs, set objectives, discuss the nursing interventions and evaluate the interventions of care carried out). As per lecture notes, students are expected to apply the clinical reasoning cycle to address the case scenario:

  • Consider the person's situation
  • Collect, process and present related health information
  • Identify and prioritise at least three nursing problems/issues based on the health assessment data you have identified for the person at the centre of care.
  • Establish goals for priority of nursing care related to the nursing problem/issues identified
  • Discuss the nursing care strategies to justify the nursing care provided
  • Reflect on the person's outcomes

Application of the Clinical Reasoning Cycle

Based on the stages of the clinical reasoning cycle, the outline of the essay should have:

Title Page: (not included in the essay)

  • Unit Title: NRSG370 - Clinical Integration - Speciality Practice
  • Students Name:
  • Student ID Number:
  • Speciality Area:
  • Scenario:
  • Total number of words:
  • Essay should be formatted

1. Introduction

  • introduces/outlines/situates the topic of the essay
  • clearly describes the way in which the essay will proceed
  • the essay is structured in a logical sequence so that the content flows (headings may be used to develop the structure of the paper)

2. Content

    1. Consideration of facts from the patient or situation

Consider the case scenario of your choosing based on your clinical electives as per assessment "Choose the once that best reflects your specialty placement" this is where you determine what information should be collected and how information is going to be collected.

    1. Collection of information

You need to discuss the type of information collected and why this information was collected based on the scenario for the clinical elective. For instances, the type of information collected should consider and include the history, current presenting issues and treatment plan, observations, results of investigations done medical records etc.

    1. Processing gathered information (analysing and interpreting)

The most important thing is to analyse the information that you have collected and identify areas of nursing care needs and problems. In this section, your discussion should refect analysis and interpretation of the patient's current health status using your established knowledge of physiology, pharmacology, pathology, culture, and ethics to establish needs and issues drawn form the information. This stage allows you to demonstrate synthesis of theory and experience acquired in previous and concurrent nursing units.

    1. Identify the problem

Identify and state the problems/needs or issues you have identified. It is important to identify the problems/needs/issues and the potential cause to determine the reason behind the patient's current issue. Examples:

      • Dehydration as a result of loose bowel motion x 4 and vomiting x 2 during am shift
      • Falls risk as a result of confusion and unsteady gait
      • Loss of weight as a result of poor oral intake for one week
      • Pain due to post - operative procedure - laparotomy
      • Hyperglycaemia due to poor diet and lack of knowledge on diabetes

Please note these are examples only, the nature of the problems you identify will depend on the nature of the case study and your analysis and interpretation of the situation.

    1. Establish goals

Here, you determine the nursing goals for the patient's situation. Identify and prioritise at least three nursing problems/issues based on your assessment and collected data.

    1. Take action

A significant amount of discussion should be attached to this section to reflect how you would address the three areas identified issues

Here you discuss the nursing interventions or measures you will undertaken in order to address the three nursing issues or problems. These measures should take in consideration the ethical, legal, evidence based, holistic person approach.

    1. Evaluation and Reflection

Evaluate the effectiveness of the nursing interventions you have discussed (presumably which could have been carried out or actually carried out) and reflect on how the interventions could have been improved or done better-State the potential measures that could have been considered or could have been carried out to address the problem. This phase allows you to critically analyse what has been done and how best the care was carried out or could have been improved.

3. Conclusion

the essays ends with a cogent, defendable conclusion that summarises the discussion.

4. References

Provide a list of references used in your discussion

Students are expected to apply the clinical reasoning cycle to address the case scenario using the following format:

  • Provide an introduction
  • Consider the person's situation
  • Collect, process and present related health information
  • Identify and prioritise three nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care.
  • Establish goals for priority of nursing care related to the nursing problem/issues identified
  • Discuss the nursing care of the person; link it to assessment data and history.
  • Evaluate your nursing care strategies to justify the nursing care provided.
  • Reflect on the person's outcomes/your learning
  • Provide a conclusion
  • List of references

The Marking Criteria

Please refer to the marking criteria

Here are some of the points in conjunction with the marking criteria which you should consider when applying the marking criteria to your case study essay:

Content: 50%

  • Refer to the stages of the clinical reasoning cycle
  • Clearly identifies and prioritises 3 relevant nursing issues/problem
  • the case study essay focus has been addressed and discussed as per clinical reasoning cycle
  • the case study essay content has clear links to contemporary nursing practice of the clinical elective area and discusses the provision of ethical, legal, evidence-based, holistic person-centred care, including the establishment of realistic and relevant goals
  • the case study paper demonstrates a depth of understanding of the topic and significant issues as per scenario and clinical elective area.

Critical thinking, reasoning and evaluation of evidence: 30%

the essay demonstrates a high degree of critical thought and insight by:

  • providing a justification/rationale for the argument/discussion
  • Demonstrating you have reflected on the complex issued surrounding the three problems identified.
  • Discussing the topic from differing perspectives, ethical, legal, evidence-based, holistic person-centred care thereby providing a balanced discussion of the problems.
  • analysis is related to nursing care and issues/problems, and is presented and supported by adequate and appropriate evidence.

Paragraph, structure/intelligibility: 10%

  • Organisation and presentation of content
  • There are clear linking sentences that link each paragraph to the next area consistently
  • introduces/outlines/situates the topic of the essay
  • clearly describes the way in which the essay will proceed
  • the essay is structured in a logical sequence so that the content flows (heading may be used to develop the structure of the paper)

Sources & Referencing: 10%

  • credible and relevant references are used. A broad range of in-text citations has been used
  • Accurate use of APA referncing style in all instances. The referencing style used throughout the paper is congruent with the Apa style
  • the reference list is accurate (i,e no missing page numbers, volumes, correct title etc), complete (i.e no references in the body of the paper are missing from the reference list) and consistent with the APA referencing style.
  • the references cited are contemporary (i.e not more than 10 years)
  • there is evidence in the paper that the student has searched widely for information related to the topic/issue
  • the student has acknowledged all sources of information used

Please refer to the unit outline, case study scenario on LEO and marking guide for information about assessment

NRSG370 Assessment Task 3: Case Study - Oncology

Mrs Zata Zata, a 46-year-old with Sigmoid Adenocarcinoma Stage IV

Mrs Zata Zata, a 46-year-old female, had 2-mouth history of passing dark blood stained stools per rectum when she ws referred by her medical General Practitioner (GP) to the hospital after experiencing severe cramping and bloody diarrhoea. She underwent a colonoscopy. which demonstrated an obstructive lesion in her sigmoid colon and had laparoscopic sigmoid colectomy a week ago. Pathology biopsy results shows infiltrating and poorly differentiated adenocarcinoma.

Past medical history

  • Mild hypertension and hyperlipidemia
  • Past surgical history: appendectomy at age 25
  • Family history: father died at age 66 with cancer of unknown origin
  • Social history: married with 2 children, ages 23 and 20; she is currently separated from her husband

Vital signs

Temperature, 37.8, pulse, 72; respirations, 22; blood pressure (BP), 166/85

Blood Result:

CEA> 25 ng/ml; CA- 19-9>120 U/ml; Hb 88; Neutrophils <500/mcl

Current medications:

  • Rosuvastatin 20mg daily
  • Metoprolol 25mg BD
  • Pantoprazole, 40 mg twice daily
  • Coloxyl and Senna 2 tablets - BD
  • Targin 10mg TDS
  • Endone 5-10mg QID (maximum dose in 24 hours 30mg)

PRN medications

  • Panadol 1 gm (for pain)
  • Metoclopramide 10mg (for nausea)

Plan of Care

To be treated with six cycles of Chemotherapy to be followed by Radiotherapy

Mrs Zata ia complaining of severe pain; with her pain score ranging between 8-10 at night.

She also indicates that she has not opened bowels for four days and she has not been sleeping at night. Mrs Zata has lost 5kg in the last two weeks. Doctors state she is to remain in hospital to improve on her neutropenic state as per last blood results. The day nurse report that Mrs Zara has been refusing to get out of bed and has been refusing to eat.