Developing appropriate critical thinking, clinical reasoning and sound clinical decision making processes and strategies essential for safe, evidence-based and competent nursing practice in medical surgical settings.

NUR250 Medical Surgical Nursing 1 S1 2016 NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 Before you begin NUR250 Assessment 1 It is strongly recommended that students revisit and ensure they understand the University and Unit policies and guidelines related to academic integrity, plagiarism, submission, extension, late submission and resubmission. Information or links to related documents are on the Assessments menu on NUR250 Learnline It is the student’s responsibility to have read, understood and, if required, sought clarification of Assessment 1 information, including topic and tasks, requirements and related University and/or Unit policies and guidelines The Unit Coordinator cannot be held responsible for information about Assessment 1 that students may access outside of the NUR250 Learnline site or the communication tools used in NUR250. This includes information students may access from other students, whether enrolled in the unit or not, using social media tools such as Facebook and/or friends and/or colleagues they may discuss their assignment with. The Unit Coordinator is the person to contact if you have any questions or queries NUR250 Assessment 1 Topic: Nursing care of a patient with altered skin integrity Due date: 1500 Wednesday Week 7 Length: 2000 words Contribution to overall grade: 40% NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 2 Aim and purpose of Assessment 1 Assessment 1 is the only written academic assignment in NUR250. The aim and purpose of Assessment 1 is to provide students the opportunity to demonstrate they:  Are developing their ability to locate, interpret, integrate, synthesize and apply nursing knowledge from NUR250, other units they have completed and a range of current, reliable sources to a patient case or scenario they may meet in day to day nursing practice in medical surgical settings  Are developing appropriate critical thinking, clinical reasoning and sound clinical decision making processes and strategies essential for safe, evidence-based and competent nursing practice in medical surgical settings  Are able to focus their attention to the needs of the individual patient as the key concern of nursing practice in medical surgical settings  Are able to explain and justify or defend their nursing care decisions  Have a developing understanding of the role and scope of practice of the registered nurse in the Australian health care context  Are progressing towards the level of professional written communication required for nursing practice in Australia  Are demonstrating ethical and professional practice by adhering to the University’s academic integrity standards and plagiarism policy NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 3 NUR250 Assessment 1 Assessment 1 is to be prepared and submitted following the guidelines below. Academic literacy and academic integrity guidelines Note: Marks are allocated for following presentation guidelines and attention to academic integrity and literacy requirements. See the Assessment 1 marking criteria for full details. Academic Literacy Assessment 1 is to be submitted and presented:  On the Assessment 1 template located in the Assessment 1 folder on NUR250 Learnline  As a computer generated document in Word format. o It is the student responsibility to ensure their assignment is converted to a Word format document before submission. Other word processing software or applications may not be compatible with Learnline and may interfere with formatting of your document and timely marking of your assignment  1.5 spaced in either Arial font size 10 or 11 or Times New Roman or Calibri font size 11 or 12  In clear, coherent Australian English that demonstrates progression towards the standard for written communication for professional nursing practice in Australia  Using appropriate professional terminology  Contents page, title page, introduction and conclusion are NOT required  With no acronyms, abbreviations and/or nursing jargon  Writing style is variable, depending on task. See specific task information for guidelines  Referencing is required when and where appropriate. Refer to task information for guidelines. (See academic integrity information below)  No more than 10% over or under that stated word count o Note: Headings, any task information copied in and in-text citations are included in the word count  Use of trade names is not acceptable. Only generic terms or names are to be used when referring to specific medications or other prescribed treatments or resources that may be used in nursing practice NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 4 Academic Integrity: Acknowledging and using the work of others Students are reminded of their academic responsibilities and professional nursing practice requirements when using the work of others in assignments. Reminder: Marks are allocated for academic integrity. See the marking criteria for Assessment 1 for full details. Breaches of academic integrity will be lodged on the University system and may have serious consequences for students.  All information is to be interpreted and restated in your own original words demonstrating your ability to interpret, understand and paraphrase material from your sources  It is recommended that direct quotations be kept to an absolute minimum in number and length. It is far better to paraphrase to demonstrate your understanding  Your thoughts and ideas are to have complete, correct and consistent in-text citations with full and complete publication details in the reference list in CDU APA 6th (Reference list is to start on a new page at the end of the assignment) Academic integrity: Draft checking for inadvertent breaches of academic integrity To assist students to check their final draft assignments for possible breaches of academic integrity, there is a Draft Checking site on NUR250 Learnline.  A few days before you submit your assignment, submit a draft copy of your assignment to generate a report for you to check  Be aware that the report will not be generated immediately, it can take several hours to be available  Ignore information at the beginning of the template and assignment information such as the headings you have been asked to use that will be common to all assignments  Pay attention to any highlighted content in your response for each item. Check any material identified as possible plagiarism and review it to either improve paraphrasing or check it has been appropriately acknowledged as a direct quote and/or referenced. A word of caution when using SafeAssign. SafeAssign only matches text to the range of documents and internet sites it has access to or to assignments that have been previously submitted on the CDU system. It is not 100% accurate and does not guarantee that there are no breaches of academic integrity in your assignment. SafeAssign may not detect material taken from sources it does not have access to or that it doesn’t recognise as a match. Students are strongly advised to manually edit and check their assignment to ensure material has been appropriately paraphrased or appropriately acknowledged and referenced. Your lecturer and assignment markers will check your sources where they have concerns as to the originality of your work. NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 5 Academic Integrity: Use of current, reliable evidence for practice Markers must be able to access ALL your sources. All resources must be accessible via CDU databases or freely available by internet search. Although not always a requirement of CDU APA, students are requested to include all URLs in your reference list for this assignment and to ensure all URLs are active. Do not remove the hyperlinks on URLs.  All resources for NUR250 assignments should be from quality, reliable and reputable nursing journals. This is where you will find information about the nursing management of patient/health problems. Remember that you will have to apply information from other countries to the Australian health and nursing context.  In some items, it may be appropriate to use articles from other journals. If you locate what you think is a relevant article from a non-nursing journal, carefully evaluate the article to ensure it is relevant to nursing, and/or that the information is relevant to the role and scope of practice of the RN in Australia.  All resources must be dated between 2008 and 2016  There must be at least 12 peer-reviewed journal articles cited in your assignment. Articles reporting original research, formal literature and/or systematic reviews are the preferred resources.  Only one textbook can be cited as a reference in the assignment and it must be a current edition. This includes any books from the CDU Library eBook collection. If you must use a textbook, one of the set texts is the preferred reference.  Relevant documents from reputable, reliable, professional websites may be used where it is appropriate to do so.  All resources cited in your assignment must have complete and correct details in the reference list, including active URL Resources that are NOT appropriate The following are NOT appropriate resources as they cannot be considered reliable sources of information:  Textbooks for lower level nursing courses. For example, any edition of Tabbner’s Nursing Care (Funnell and/or Koutoukidis, et al) does not have the depth or breadth of information required by a RN.  Dictionaries  Journal abstracts  Journal articles that are not in English  Journal articles that cannot be accessed via CDU databases or search engines  Websites such as Wikipedia, myDr, Nurse.com, Scribd, and other nursing/health/medical blog sites  Information from organisational intranet sites or other sites that require registration or log in to access material. This is not publicly available information. Cont’d next page NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 6  Consumer websites such as the Better Health Channel or consumer information from government departments or agencies  Preview copies of books from online retailers Submission It is the student’s responsibility to:  Ensure Assessment 1 is submitted on the template provided. (See the Assessment 1 folder on NUR250 Learnline)  Ensure the correct copy of your assignment is submitted on the correct submission point for the assignment by the due date.  Have read, understood and, if required, clarified the University/School and/or NUR250 policies and guidelines related to extensions, late submission and resubmission  Ensure the academic integrity of assignments before submission Assignments are to be submitted:  In Word format following the presentation guidelines above and on the Assessment 1 template provided in the Assessments 1 folder on the on NUR250 Learnline.  Via the correct Assessment 1 SafeAssign submission point on NUR250 Learnline Assessment Submission menu Only one submission is allowed. Resubmission of assignments and supplementary assessments are not available. Assignments not submitted on the correct submission point will not be accepted or marked. Assignments submitted with no student identification on the document will not be marked until all other assignments have been marked and student ID can be confirmed Label the assignment file you submit in the following format: Surname, Student Number, NUR250 Assessment 1 Emailed, faxed, posted or hand-delivered assignments will not be accepted or marked NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 7 Assessment 1: Topic Nursing care of a person with a major burn Source: Flickr, may be subject to copyright Meet Marion You will be caring for her today Shift handover: Marion was admitted 5 days ago with burn injuries to her lower legs, back and posterior side of her lower arms. Extent of the burns is estimated at approximately 40% and depth is variable but there is an extensive area of partial and full thickness burn on her back and posterior thighs. Marion was transferred to the ward from the intensive care unit yesterday afternoon following fluid resuscitation and initial surgical debridement. She is now 6 days post burn injury. Today she is booked on the afternoon theatre list for further debridement, harvesting of autologous split skin grafts and replacement of the nasogastric tube. Overnight her vital signs have been stable, urine output satisfactory and she is reporting she is comfortable with minimal pain. She is currently nil by mouth in preparation for theatre but has been tolerating oral food and fluids prior to this. However, there has been some concern about caloric and nutrient intake. She has intravenous fluids running at maintenance and an indwelling catheter in situ. She is not reporting any nausea or other discomfort at present but is getting frustrated at having to rely on others to help with her personal care and daily activities. Full and partial thickness burns are covered with a silver impregnated dressings that are difficult to keep in place due to location of injuries. Superficial burns have hydrogel dressings where possible and some areas require regular application of an emollient. Current medications include a transdermal fentanyl patch, panadeine forte 4/24 and nitrous oxide prn as well as an anti-emetic, vitamin and mineral supplements and an aperient. Prophylactic intravenous antibiotics were commenced this morning. Her husband is visiting regularly but his time is limited due to childcare and work commitments. He brings their 2 young children on most afternoons for a short visit. There are no other family members living locally but her mother and sister are arriving in the next few days. Marion is quite concerned about how the family is going to manage over the next few months. NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 8 Assessment 1 Tasks: Using the template provided in the Assessment 1 folder and, based on the handover you received at the beginning of your shift today, other information included below and current reliable evidence for practice, address the following 5 tasks. Do not make up or assume information in relation to or about Marion, the photo is not an indication of her age or appearance. Only use what you know from the information you received today. Note: Students are expected to demonstrate they have read beyond the set texts to prepare their responses and nursing care plan and can apply and integrate knowledge to practice. Reliance on text books alone is no guarantee that your information is current and reliable evidence for practice. However, set texts are a good place to start to identify key points and to develop search strategies to locate appropriate journal articles. Task 1: Based solely on the handover you have received and in grammatically correct sentences identify the  3 nursing problems you think are the most important while caring for Marion today AND For each nursing problem above, identify  What it is related to  Why it is a priority for you today Tips for Task 1:  Medical diagnoses are not acceptable  Your explanation must be specific; you will need to say more than “burn injury”  Explanations must be referenced (200 words, 5 marks) Task 2: Based solely on the handover you have received and using the template provided in the Assessment 1 folder, develop a full nursing care plan for Marion today. Your plan must address the physical, functional and psychosocial aspects of care. For each nursing problem on your plan, identify your  Goal of care  Nursing interventions or actions  Rationales for interventions  Expected outcome of care Tips for Task 2:  Dot points may be used in the nursing care plan template  See Weeks 1 & 2 learning material for guidance with care plan  Appropriate professional language must be used, no abbreviations or nursing jargon  Rationales must be referenced. It is strongly recommended only current, reliable journal articles be used as references when providing rationales (950-1000 words, 30 marks) NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 9 Task 3 Two important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications and how to monitor the patient to ensure they are responding to prescribed medications as they should. In grammatically correct sentences and using current, reliable evidence for practice, briefly explain why Marion has been prescribed o Fentanyl via transdermal patch o Vitamin and minerals supplements o An aperient AND  Explain o The nursing responsibilities associated with administering the 3 medications above o How you will monitor Marion to ensure she is responding appropriately to these 3 medications you are administering today Tips for Task 3:  References are essential in Task 3  Revisit Week 3 for guidance with RN role and responsibilities (350 words, 10 marks) Task 4: An important and legal requirement of nursing practice is to communicate relevant information, actions and outcomes related to patient care and provide accurate reflection of the health status of the patient, their responses to care and the patient’s perspective. Using a succinct, narrative format and only the relevant information in the shift handover and the additional information below  Write a progress note entry that clearly and succinctly outlines the important information other health professionals, including other nurses, need to know about Marion at the end of your shift today Additional information you need to know for Task 4 During your shift the following information and events have occurred On return to ward following surgery  Post op orders: NBM, nasal prong oxygen to continue til review tomorrow morning, IV fluids, IDC, analgesia changed to morphine via PCA, IV antibiotics continue, burn dressings to remain intact for 24 hrs, donor site dressings to remain intact for 3 days, NBM until review, no enteral feeds until review.  Post op assessments: o Vital signs slightly elevated o 02 saturations 98% o Pain score 3-4 o Drowsy but easily roused o Dressings intact, small amount of ooze o IV site satisfactory o Urine output > 30 ml/hour Before the end of your shift  Marion becomes more drowsy and harder to rouse  Urine output drops off  Vital signs increase, temperature is 37.8°C NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 10 Your progress note must:  Demonstrate person-centred care  Address the physical, functional and psychosocial aspects of care and reflect any changes required to the nursing care plan you developed in Task 2  Adhere to the legal and professional standards for documentation  Be in appropriate professional language  NO abbreviations or nursing jargon Tips:  Revisit Week 2 for guidance  Some student might find the ISBAR format helpful to identify what needs to be included  No introduction or opening statement is required but you will need to identify the patient, the date and time of your report and your name and designation.  Keep information succinct and to the point. Proper sentences are not required but dot points are not usually used in clinical documentation  Demonstrate your ability to think critically about what information you include or not  Resist the temptation to write your progress note as you do now or have done in the past. Demonstrate you are prepared, and have the ability to, change your practice.  References are not appropriate in progress notes  Check and correct your spelling! (200 words, 5 marks) Task 5: An important part of the clinical reasoning process is to reflect on what you have done and learnt and to identify areas where you need further development and/or learning. In this item, reflect on your experience in preparing this assignment and identify  The three (3) most important things you have learnt about your level of underpinning knowledge and understanding and/or clinical reasoning skills while completing this assignment  Why these three (3) things are most important for you (200 words, 5 marks) Presentation guidelines for Task 5 only In this item you are asked to identify and explain your thoughts and feelings about a specific aspect related to this assignment. Reflective writing requires a different writing style to the rest of the assignment. As you are expressing your thoughts and feelings, you write in the first person. It is expected to see words like “I” and “my“ and phrases like “I have learnt…”, “I now understand or realise that…” We are looking for evidence that you are developing some understanding and insight about yourself. You will need more than a summary of the areas, or general statements about, where you have increased your knowledge or what aspects of the assignment you enjoyed. It is not appropriate to reference your own personal thoughts and feeling. However, if you refer to professional nursing standards and codes, information from specific sources (eg a text book) or draw on your understanding of the role and scope of practice of the registered nurse, you must provide a reference to support your statements. NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 11 Please go to next page – there are important reminders before you submit NUR250 Medical Surgical Nursing 1: Assessment 1 Topic and Tasks S1 2016 12 A reminder to  Check the submission time and day before submission  Ensure the academic integrity of your work before submission  Prepare and submit your assignment as directed in the presentation guidelines earlier in this document

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