Mrs Williamson is a 76-year-old woman admitted to your Orthopaedic ward from the Emergency Department (ED) after she had a fall at home. The ED doctor has referred Mrs Williamson for investigations regarding a possible left foot metatarsal bone fracture and ordered further investigations. Mrs Williamson has had an initial dose of 1000mg Panadol in ED 3 hours ago; with an ongoing order of 1000mg of Panadol PRN 6 hourly. The physical exam shows that Mrs Williamson has pain and redness of her left foot, which has increased over the last 3 hours despite analgesia, and her pain level now is 8/10. She is unable to bear weight on the affected foot. Mrs Williamson is oriented and alert, but concerned as she was brought to the hospital alone.
Mrs Williamson has a history of high blood pressure (hypertension) and she is on antihypertensive medication, Avapro 150mg/day. Mrs Williamson was an active member at the local bowling club and local church, but since her husband died 12 months ago, she has not attended church or bowling. When you introduce yourself to Mrs Williamson, she tells you that she “does not want to be in hospital” and asks you “when can I go home?”
Mrs Williamson’s vital signs upon admission to the ward are:
• Blood pressure 145/90 mm Hg
• Temperature 36.8° Celsius
• Pulse rate 110 beats per minute
• Respiration rate 18 breaths per minute
• Oxygen saturation 95%
Note: The purpose of this assessment is to gain knowledge of the theoretical aspect of the Clinical Reasoning Cycle.
Required Reading
Ingham-Broomfield, B. (2018). Chapter 11: Critical Thinking and the Nursing Process. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …D. Stanley, Kozier and Erb’s fundamentals of nursing (4th Aust. ed., Vol 1, pp. 192-203). Melbourne, Vic.: Pearson.
Levett-Jones, T. (2018). Chapter 13: Diagnosing. In A. Berman, S. Snyder, T. Levett-Jones, T. Dwyer, M. Hales, N. Harvey, …D. Stanley, Kozier and Erb’s fundamentals of nursing (4th Aust. ed., Vol 1, pp. 221-229). Melbourne, Vic.: Pearson.https://charteredessay.com/learning-resources-required-readings-mcgonigle-d-mastrian-k-g-2017-nursing-informatics-and-the-foundation-of-knowledge-4th-ed-burlington-ma-jones-bartlett-learning/
Levett-Jones, T. (Ed). (2018). Clinical reasoning: Learning to think like a nurse. Frenchs Forrest, NSW: Pearson
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S., Noble, D., Norton, C., . . . Hickey, N. (2010).
The five rights of clinical reasoning: an educational model to enhance nursing students ability
to identify and manage clinically at risk patients. Nurse Education Today, 30(6), 515-520.
doi:10.1016/j.nedt.2009.10.020
Task Instructions:
The following questions will explore each aspect of the clinical reasoning cycle. You MUST use the required readings, the scenario, and the Clinical Reasoning Cycle (CRC) (Levett-Jones, 2018) to assist you to answer these questions. APA referencing is required for these readings and any additional references, such as relevant assessment tools and nursing literature.
You will also be expected to use your critical thinking skills when providing your answers. Critical thinking can be defined as, -the art of analysing and evaluating thinking with a view to improving it- (Paul & Elder, 2009). Short answer questions are those written in sentence and paragraph format, and can be up to 500 words. Use the word count provided for each question as a guide to how much detail you should provide in your answers.
Task Format/ Presentation:
• Short answer questions must use full sentences and paragraphs unless stated otherwise (i.e. when asked to list you may use bullet points), and formal academic English.
• APA style in text referencing and an APA style reference list on a separate page at the end of your assignment
• Direct quotations are NOT to be used for this assignment
• 11 pt Arial font, with 1.5 line spacing.
• Include each question number as a subheading when presenting your answers (i.e. Question 1, Question 2, etc.)
• Include your name, student number, the NURS1201 course code, assignment title, and page numbers in the header and/or footer of your document.
• Word Count 1800 words.
Task Questions:
1) Using the Levett-Jones et al. (2010) article, discuss the importance of clinical reasoning in relation to preventing patient deterioration and maintaining safe nursing practice. (200 words maximum) [4 marks]
2) The first phase of the CRC is: Consider the Patient Situation. Identify the aspects that are considered when evaluating the patient situation; and why it is an important initial step in the CRC? (100 words maximum) [2 marks]
3) The second phase of the CRC is: Collecting Cues and Information (250 words maximum) [Total 8 marks]
a) Discuss the importance of collecting cues. In your answer consider the possible consequences for not collecting enough cues, and how therapeutic communication could impact the collection of cues. [2 marks]
b) Current information: Using the scenario, provide a list of all the cues that you identify based on the current information for Mrs Williamson. [ 3marks]
c) Gather new information: Based on the current information listed for 3b, list three (3) additional assessments that you would conduct and provide a brief rationale for each, using the literature to support this discussion. [3 marks]
Note: You can include any assessment that relates to Mrs Williamson. The assessment does not have to relate to the course content.
4) The third phase of the CRC is: Processing Information. As you progress through the degree you will become more confident with processing information, at this point we will focus on the following: (250 words maximum) [Total 8 marks]
a) Briefly describe what is involved in the processing information phase. As a nurse, what is the purpose of processing information? [ 2 marks]
b) Identifying normal versus abnormal: Using your list of cues in question 3b, list what cues you consider are not in the normal range for Mrs Williamson (using supportive literature) [ 4 marks]
c) Discriminate: From the cues identified above, identify the one cue that would be your priority for Mrs Williamson (what are you most concerned about), and why? [ 2 marks]
5) The fourth phase of the CRC is: Identifying problems or issues. (The terms “nursing problem”, “nursing issue” and “nursing diagnosis” are interchangeable during your degree). The purpose of generating a nursing problem and stating what it is related to and evidenced by is to further your understanding of relationships when using clinical reasoning. (250 words maximum) [Total 10 marks]
a) Explain the difference between an actual and a potential (at risk) nursing diagnosis. [ 2 marks]
b) Explain the role of “related to” and “evidenced by” statements when making a nursing diagnosis. (When answering this question explain what information nurses use to make these statements? Be sure to distinguish which information can be used for “related to” and which information that can be used for “evidenced by” statements in your answer). [3 marks]
c) Identify one (1) priority actual nursing diagnosis for Mrs Williamson using “related to” and “evidenced by” statements. [3 marks]
d) Identify one (1) potential nursing diagnosis for Mrs Williamson using a “related to” statement. [2 marks]
An example of nursing diagnosis statement is:
Altered body temperature higher than Normal – related to – Infection process evidenced by – increase in temperature 38.5oC (febrile) and heart rate 98 (tachycardia).
Note:
• there may be multiple cues that provide the evidence of a nursing problem
• this is only an example; don’t use this example for this assessment
6) The fifth phase of the CRC is: Establishing goals. Goals must be S.M.A.R.T (Specific, Measurable, Attainable, Realistic and Timely). Identify one (1) appropriate SMART goal for each diagnosis. (50 words/ 2 goals maximum) [4 marks]
Example: to return body temperature to below 37.5oC within one hour
7) The sixth phase of the CRC is: Take action. Taking action identifies nursing actions/interventions that you will undertake to achieve the goal. The action should be related to the priority nursing diagnosis identified in Phase four (question 5, part C of this assessment). Nursing actions/interventions may include Assessments, Education, Medication, and Care activities. (Note: Please do not include the nursing action of
Consultation/communication/referral) (200 words maximum) [Total 10 marks]
a. Assessment: Identify an Assessment that you will undertake with Mrs Williamson and provide a rationale. [2.5 marks]
b. Education: Identify what Education you could provide to Mrs Williamson and provide a rationale. [2.5 marks]
c. Medication: Identify a medication related action for Mrs Williamson and provide a rationale. [2.5 marks]
d. Intervention/care: Identify a nursing care you could provide to Mrs Williamson and provide a rationale. [2.5 marks]
8) The seventh phase of the CRC is: Evaluation. This ensures that you know what you expect to see as a result of your action/nursing intervention. What is the purpose of evaluating nursing interventions as part of the clinical reasoning cycle? Consider how and when nurses evaluate nursing interventions. (150 words maximum) [ 4 marks]
9) The eighth and final phase of the CRC is: Reflection. Reflection is an important part of nursing, the clinical reasoning process, and assists with your future learning. After undertaking this assessment task, use the Gibbs reflective cycle to reflect on what was your most challenging moments in clinical reasoning and why this so? (100 words maximum) [4 marks]
NURS1201 – Written Assessment – Marking Rubric – 30 % weighting
Question Related
Course
Outcome An Unsatisfactory Answer… (Fail Grade) A Satisfactory Answer… (Pass – Credit Grade) An Exemplary Answer…
(Distinction – High Distinction Grade)
1
(300 words) 2, 8 0-1 marks 2-3 marks 4 marks
•
•
• Uses limited, inappropriate, or no readings in answer Shows a limited or no attempt to address ideas from required reading
Makes unclear or no links between CRC, nursing practice, and patient safety •
•
• Uses required reading in answer
Addresses key ideas from required reading in discussion makes clear links between CRC, nursing practice, and patient safety •
•
• Uses required reading and additional source/s in answer Elaborates and provides details about key ideas from required reading in discussion
Demonstrates a deeper level of reasoning and thinking about the importance of CRC in relationship to nursing practice and patient safety
2
(100 words) 7, 8, 9 0 mark 1 mark 2 marks
•
•
• Attempts to, incorrectly, or fails to identify
information required for evaluating a patient situation Attempts to, incorrectly, or fails to explain the role of considering the patient
Offers limited, incorrect, or no reasoning about the importance of the first phase of CRC •
•
•
Identifies essential information required for evaluating a patient situation
Provides explanation of the role of considering the patient
Provides some reasoning about the importance of the first phase of CRC •
•
•
Identifies essential information required for evaluating a patient situation
Provides a clear explanation of the role of considering the patient
Demonstrates a deep understanding of the importance of the first phase, and how this step relates to CRC and nursing practice
3 A, B &
C
(300 words) 2, 7, 8 0 – 2 marks 3-5 marks 6-8 marks
•
•
•
•
•
• 3A – demonstrates limited to no understanding of the role/purpose of collecting cues
3A – makes incorrect, unclear or no links between collecting cues, patient safety, and therapeutic communication
3A – Uses limited or no readings in answer
3B – lists incorrect, some, or no current information for Mrs Williamson (bullet points accepted)
3C – unclear or fails to identify relevant assessment to conduct, with no explanation of their relevance for
Mrs Williamson
3C – uses inappropriate or no literature •
•
•
•
•
• 3A – demonstrates an understanding of the role/purpose of collecting cues
3A – makes clear links between collecting cues, patient safety, and therapeutic communication
3A – Uses required readings in answer
3B – lists all current information for Mrs Williamson
(bullet points accepted)
3C – identifies relevant assessments to conduct, and offers some explanation of why these assessments are relevant for Mrs Williamson (bullet points accepted) 3C – uses appropriate literature to support answers •
•
•
•
•
• 3A – demonstrates a thorough evidenced-based understanding of role/purpose of collecting cues
3A – explains the relationship between collecting cues, patient safety, and therapeutic communication to justify its importance; links back to role/purpose
3A – Uses required and additional reading/s in answer
3B – lists all current information for Mrs Williamson (bullet points accepted)
3C – identifies relevant assessments to conduct, and clearly explains why these assessments are relevant for Mrs Williamson (bullet points accepted)
3C – uses quality and relevant literature to support answers
4 A, B &
C
(250 words) 6, 8 0 – 2 marks 3 – 5 marks 6-8 marks
•
•
• 4A – lists some, none or incorrect aspects of processing information phase
4A – provides limited, incorrect, or no explanation of the purpose of processing information in nursing practice
4A – Uses limited or no readings in answer •
•
•
• 4A – outlines aspects of the processing information phase
4A – explains the purpose of processing information in relation to nursing practice
4A – uses required readings to support answer 4B – lists abnormal cues for Mrs Williamson (bullet points accepted) •
•
•
•
• 4A – outlines aspects of the processing information phase
4A – explains the purpose of processing information in relation to nursing practice
4A – uses required and additional reading/s to support answer 4B – lists abnormal cues for Mrs Williamson (bullet points accepted)
4C – identifies a priority from the listed cues
•
•
• 4B – lists some, none, or incorrect abnormal cures
(bullet points accepted)
4C – identifies no or an incorrect priority
4C – provides limited, incorrect, or no rationale, and uses inappropriate or no readings to support answer •
• 4C – identifies a priority from the listed cues
4C – provides a brief rationale for priority, and uses evidence to support answer • 4C – provides a clear rationale for priority that is based on evidence from the scenario and literature, demonstrating superior clinical reasoning
5 A, B, C
& D
(300 words) 6, 7, 8 0 – 3 marks 4 – 6 marks 7 – 10 marks
•
•
•
•
•
• 5A – attempts to, incorrectly, or fails to define actual and potential nursing diagnoses or explain how these are used in nursing practice
5A & B – Uses limited, inappropriate, or no readings in answer
5B – attempts to, incorrectly, or fails to define
‘related to’ and ‘evidenced by’ statements
5B – fails to identify or identifies incorrect information to be used in these statements 5C – fails to or provides incorrect actual nursing diagnosis
5D – fails to or provides incorrect potential nursing diagnosis •
•
•
•
•
• 5A – defines actual and potential nursing diagnoses, and offers a brief explanation of how these are used in nursing practice
5A & B – uses required readings in answer
5B – defines ‘related to’ and ‘evidenced by’ statements
5B – identifies types of information that can be used in
‘related to’ and ‘evidenced by’ statements
5C – provides an accurate actual nursing diagnosis using
‘related to’ and ‘evidenced by’ statement
5D – provides an accurate and relevant potential nursing diagnosis for Mrs Williamson •
•
•
•
•
• 5A – defines actual and potential nursing diagnoses, and provides a clear and detailed explanation of how these are used in nursing practice and care
5A & B – uses required and additional reading/s in answer
5B – defines ‘related to’ and ‘evidenced by’ statements
5B – identifies types of information that can be used in ‘related to’ and ‘evidenced by’ statements, explains the role of this information, and makes links between CRC phases
5C – provides an accurate actual nursing diagnosis using
‘related to’ and ‘evidenced by’ statement
5D – provides an accurate and relevant potential nursing diagnosis for Mrs Williamson
6
(50 words) 2, 8, 9 0 – 1 marks 2 – 3 marks 4 marks
•
•
• Fails to or identifies inappropriate SMART goal for actual diagnosis
Fails to or identifies inappropriate SMART goal for potential diagnosis
Goals are unclear or do not use SMART format •
• •
• Identifies 1 SMART goal for actual diagnosis
Identifies 1 SMART goal for potential diagnosis Goals are appropriate for Mrs Williamson and the diagnoses
Goals are written clearly •
• •
• Identifies 1 SMART goal for actual diagnosis
Identifies 1 SMART goal for potential diagnosis
Goals are appropriate for Mrs Williamson and the diagnoses
Goals are written clearly and concisely, and are evidenced-based
7 A, B, C
& D
(200 words) 2, 7, 8, 9,
12 0 – 3 marks 4-6 marks 7 – 10 marks
•
•
•
•
• 7A – fails to or identifies an inappropriate assessment action and rationale
7B – fails to or identifies an inappropriate education action and rationale
7C – fails to or identifies an inappropriate medication related action and rationale
7D – fails to or identifies an inappropriate care action and rationale
Uses unclear writing for actions and rationales, and uses limited, inappropriate or no evidence •
•
• https://essaycove.com/
•
• 7A – identifies an appropriate assessment action for Mrs
Williamson and provides brief rationale for this action
7B – identifies an appropriate education action for Mrs
Williamson and provides brief rationale for this action
7C – identifies an appropriate medication related action for Mrs Williamson and provides brief rationale for this action
7D – identifies an appropriate care action for Mrs
Williamson and provides brief rationale for this action Actions and rationales are written clearly and are evidenced-based
•
•
•
•
• 7A – identifies an appropriate assessment action for Mrs
Williamson and provides brief rationale for this action
7B – identifies an appropriate education action for Mrs
Williamson and provides brief rationale for this action
7C – identifies an appropriate medication related action for Mrs
Williamson and provides brief rationale for this action
7D – identifies an appropriate care action for Mrs Williamson and provides brief rationale for this action
Actions and rationales are written clearly and concisely, and are evidenced-based. Rationales are supported by literature.
8
(150 words) 7, 8, 9 0 – 1 marks 2 – 3 marks 4 marks
•
• attempts to, incorrectly, or fails to describe why (the purpose) nurses evaluate nursing interventions attempts to, incorrectly, or fails to identify how and when nurses evaluate nursing interventions uses limited, inappropriate or no evidence •
• describes or attempts to explain why (the purpose) nurses evaluate nursing interventions
identifies how and when nurses evaluate nursing interventions; identifies various evaluation tools and •
• Explains why (the purpose) of evaluating nursing interventions, with the answer demonstrating an understanding of the role of evaluation within CRC.
Identifies how and when nurses evaluate nursing interventions; identifies various evidenced-based evaluation tools and
• measures; attempts to link explanation of evaluation to the scenario
uses required readings in answer measures; clearly articulates evaluation in relationship to the SMART goals for Mrs Williamson.
• uses required and additional reading/s in answer
9
(100 words) 8 0 – 1 marks 2 – 3 marks 4 marks
•
• •
•
• Limited or no use of the Gibbs cycle is demonstration the reflection
attempts to or does not reflect on individual learning Shows limited or no comprehension of CRC and its phases
Attempts to make or makes unclear links between CRC and nursing practice uses limited, inappropriate or no evidence •
•
•
• Use of the Gibbs Cycle is demonstrated in the reflection Demonstrates reflection on individual learning and some comprehension of the CRC and its phases makes some links between CRC and nursing practice uses required readings in answer • Clear use of the Gibbs Cycle is demonstrated in the reflection
• Demonstrates reflection on individual learning and a sound comprehension of the CRC and its phases
• Articulates links between CRC and nursing practice, and considers application of CRC to demonstrate a superior understanding of clinical reasoning
• uses required and additional reading/s in answer
Academic literacies 0-1 marks 2-4 marks 4-6 marks
•
•
•
• fails to use required readings / uses inappropriate sources multiple errors in APA in text citations and reference list
uses direct quotes / attempts to paraphrase uses unclear writing with multiple errors •
•
•
• Uses the 4 required readings
Uses APA referencing for in text citations and reference list with minimal errors
Uses paraphrasing / doesn’t use direct quotes Uses clear and concise writing, with minimal grammatical, spelling, or written errors • Uses the 4 required readings and 2 additional high quality academic readings
• Uses APA referencing for in text citations and reference list with no errors
• Uses paraphrasing / doesn’t use direct quotes
• Uses clear and concise writing, with no grammatical, spelling, or written errors
Feedback: Total Mark:
/60 marks