NURSING 7113 - Recognition & Response to Clinical Deterioration

North Terrace Campus - Semester 1 - 2014

This course will equip the Acute Care Nurse with physical assessment skills that enable early recognition of the adult patient suffering unexpected clinical deterioration, leading to timely and appropriate management. It will provide both theoretical and clinical components that enable application to practice. Synchronised online collaborative learning will support learning and teaching goals. Topics will include, but are not limited to, pathophysiology and emergency management using a systematic approach to body systems, supported by Australian Resuscitation Guidelines where appropriate.

  • General Course Information
    Course Details
    Course Code NURSING 7113
    Course Recognition & Response to Clinical Deterioration
    Coordinating Unit School of Nursing
    Term Semester 1
    Level Postgraduate Coursework
    Location/s North Terrace Campus
    Units 3
    Contact Flexible delivery mode with online classroom lectures plus one on-campus workshop during the semester
    Assumed Knowledge Basic anatomy and physiology of the human body
    Restrictions Available to M.NursSc students only
    Course Description This course will equip the Acute Care Nurse with physical assessment skills that enable early recognition of the adult patient suffering unexpected clinical deterioration, leading to timely and appropriate management. It will provide both theoretical and clinical components that enable application to practice. Synchronised online collaborative learning will support learning and teaching goals. Topics will include, but are not limited to, pathophysiology and emergency management using a systematic approach to body systems, supported by Australian Resuscitation Guidelines where appropriate.
    Course Staff

    Course Coordinator: Mrs Sindy Millington

    School of Nursing Office:
    Student Liaison Office: Ph - +61 8313 3595; Email - nursing.studentliaison@adelaide.edu.au

    Course Timetable

    The full timetable of all activities for this course can be accessed from Course Planner.

  • Learning Outcomes
    Course Learning Outcomes
    1 Appraise the rationale and effectiveness of nursing assessment and interventions applied to seriously ill patients in the acute care setting.
    2 Demonstrates advanced and focused physical assessment in clinical practice in an acute care scenario with recognition of clinical deterioration in a timely manner
    3 Retrieves, critically evaluates and prioritises appropriate and timely interventions using best available evidence
    4 Expresses critical thinking skills through critical evaluation and nursing reflection on practice and the effectiveness of interventions.
    5 Demonstrates leadership through safe practice in accordance with legislation, professional codes and specialty competencies and guidelines in relation to current skills, knowledge and attitudes
    6 Demonstrates Integration of clinical skills and rigorous academic knowledge to practice in an acute care scenario
    7 Demonstrates advanced patient care within the multidisciplinary team using a culturally sensitive approach in an acute care scenario
    University Graduate Attributes

    This course will provide students with an opportunity to develop the Graduate Attribute(s) specified below:

    University Graduate Attribute Course Learning Outcome(s)
    Knowledge and understanding of the content and techniques of a chosen discipline at advanced levels that are internationally recognised. 1, 3
    The ability to locate, analyse, evaluate and synthesise information from a wide variety of sources in a planned and timely manner. 4-6
    An ability to apply effective, creative and innovative solutions, both independently and cooperatively, to current and future problems. 2
    Skills of a high order in interpersonal understanding, teamwork and communication. 4, 7
    A proficiency in the appropriate use of contemporary technologies. 3, 7
    A commitment to continuous learning and the capacity to maintain intellectual curiosity throughout life. 4-5
    A commitment to the highest standards of professional endeavour and the ability to take a leadership role in the community. 5
    An awareness of ethical, social and cultural issues within a global context and their importance in the exercise of professional skills and responsibilities. 7
  • Learning Resources
    Required Resources
    Texts
    McCance, KL & Heuther, SE 2010, Pathophysiology: The Biologic Basis for Disease in Adults and Children, 6th edn, Mosby Elsevier, Missouri.

    Sole, ML Klein, DG & Moseley, MJ 2009, Introduction to Critical Care Nursing, 5th edn, Saunders Elsevier, St Lois, Missouri.

    The prescribed texts are integral to the course and may be purchased from all or some of the following outlets:

    Unibooks
    The University of Adelaide, Adelaide SA 5005
    Phone:    +61 8 8125 5160
    Email:    adelaide@unibooks.com.au
    Website:    www.unibooks.com.au

    Ramsay – Medical books and more
    Located at Unibooks, Adelaide Store, Gate 10 (off Victoria Drive), Union Building,Adelaide SA 5000
    Phone:  +61 8 8125 5195 or 1300 796 106
    Fax:  +61 8 8231 2069
    Email:  sales@ramsaybooks.com.au
    Website:  www.ramsaybooks.com.au

    Encompass Bookshop
    Shop 20, Renaissance Arcade,128 Rundle Mal, lAdelaide SA 5000
    Phone:   08 8224 0886
    Fax:   08 8223 3570
    Email:  adelaide@encompassbooks.com.au
    Website: www.encompassbooks.com.au


    Online Classroom technology
    To connect to the VC you will require:
    •    a computer – either a PC-based or a Macintosh-based machine
    •    Internet access – there seems to be little difference between broadband and dial-up connections other than the speed of the initial connection
    •    minimum of a 56K modem
    •    a multimedia headset – it must have both earphones and microphone (These are available in computer variety stores).



    Recommended Resources
    The readings for this course are available electronically via MyUni.

    Please note: it is your responsibility to organise printing should you prefer a hard copy of the readings.
    Online Learning
    Online Classroom
    The online classroom (OC) technology will be used for lectures and tutorial discussions on a weekly basis each Thursday from 10:30-12:30 during this semester.

    MyUni
    All students enrolled in a postgraduate coursework nursing program have access to the School of Nursing – Postgraduate Coursework Student Centre on MyUni. If you would like the opportunity to network with other students, you can use the Communication features in the site. This site will also feature information about the latest news and events at the School of Nursing.

    Unified
    http://unified.adelaide.edu.au/
    UNIFIED is your one-stop shop for email, calendar, MyUni and Access Adelaide. It even allows you to search the Library.
    UNIFIED is available to all active students; with a single login you can access your student systems and personal information through a central website. Login with your Student ID ("a1234567") and Password.

    For more information, including easy to follow instructions visit https://unified.adelaide.edu.au/web/mycampus/home.

    Library Resources
    Help for Nursing Students
    The University of Adelaide Library has a website to help nursing students use the library and its resource (www.library.adelaide.edu.au/guide/med/nursing).

    Remote student library service
    The University of Adelaide Library provides a document delivery and loans service to non-metropolitan students who do not visit a University of Adelaide campus to attend classes (www.adelaide.edu.au/library/docdel/external.html).
  • Learning & Teaching Activities
    Learning & Teaching Modes
    This course will be delivered through the Flexible Delivery Mode with Online Classroom Lectures.
    Students will participate in synchronous online collaborative learning for 2 hours each week and will be provided with course materials.

    You are provided with key points for each of the topics in the course and you are required to address these topics through readings and required activities. On-line learning using ‘On-line Classroom’ (OC) and ‘MyUni’ are used in the delivery of this course. There is also a workshop associated with this course on Thursday 12th June – Friday 13th June (in conjunction with the course Acute Care Nursing 1 students).

    Assessments will combine knowledge and practice.
    Workload

    The information below is provided as a guide to assist students in engaging appropriately with the course requirements.

    It is expected that you will need to invest about 12 hours per week of study to successfully complete this course. It is recommended that you plan your time commitment to the course at the beginning of the semester. This includes all study activities, attendance at workshops, readings and assessment. Thus some weeks it will be more and others less. It is recommended that you plan your time commitment to the course at the beginning of the semester.

    Online Classroom

    The online classroom (OC) technology will be used for lectures and tutorial discussions on a weekly basis each Thursday from 10:30-12:30 during this semester. On-line learning using ‘On-line Classroom’ (OC) and ‘MyUni’ are used in the delivery of this course. There is also a 2 day workshop associated with this course. Student participation and discussion will be expected in all sessions.

    Readings
    A reading list has been compiled for this course and will be made available through MyUni. Lecture and readings have been carefully chosen. All of these are required and recommended readings have been selected to optimise your knowledge on the topic and so that they will continue to be of use after you graduate.

    This specialist course builds upon your existing knowledge of acute disease and the appropriate management strategies and nursing skills employed to treat acute conditions. This course offers a wide variety of topics that impact the activities of acute care nurses in their practice context. Obviously everything cannot be covered in such a short time frame so issues that are common and of current relevance will be explored. Participation in the tutorials is vital in making this course a constructive and enjoyable learning experience.
    Learning Activities Summary
    The course content will include but not be limited to the following:

    1. Identification of the deteriorating patient – criteria for a medical emergency team

    2. ARC – guidelines

    3. Post-resuscitation considerations

    4. Airway assessment

    5. Oxygen therapy

    6. Adjunct airways

    7. Intubation - Drugs for intubation

    8. Emergency airway management

    9. Respiratory assessment

    10. Respiratory monitoring

    11. Arterial blood gas analysis

    12. Management of a respiratory emergency

    13. Cardiovascular assessment

    14. Cardiac monitoring

    15. Arrhythmia interpretation

    16. Management of a cardiovascular emergency

    17. Haemodynamic monitoring

    18. Vascular access devices

    19. Principles of blood pressure regulation

    20. Hypertension

    21. Neurological assessment

    22. Mechanisms of injury

    23. Emergency neurological management

    24. Mental health assessment

    25. Detention

    26. Restraint - physical and chemical
    Specific Course Requirements
    On-line learning using ‘On-line Classroom’ (OC) and ‘MyUni’ are used in the delivery of this course and you are required to attend a minimum of 80% of these classroom sessions. There is also a 2 day workshop associated with this course during week 13 (dates to be confirmed) in conjunction with Acute Care Nursing 1 students.
  • Assessment

    The University's policy on Assessment for Coursework Programs is based on the following four principles:

    1. Assessment must encourage and reinforce learning.
    2. Assessment must enable robust and fair judgements about student performance.
    3. Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
    4. Assessment must maintain academic standards.

    Assessment Summary
    Assessment Task Assessment Type Weighting Learning Outcome(s) being addressed
    Online Quiz Formative NGP 5
    Clinical Assessment Sheets(CAS) x 2 Summative 50% i.e.
    • 25% for CAS1
    • 30 % for CAS 2
    1, 2, 4, 6
    Crtitique of Practice Summative 50% i.e.
    • 20% Discussion Board.
    • 30% for written assignment
    3, 5, 7
    Online Participation Pass/Fail 1-4
    Assessment Detail

    Online Quiz    NGP
    The formative online Quiz will be available on the MyUni website in first three weeks with the content focussed on respiratory nursing assessment in recognition and response to the clinical deterioration of an acute care patient.

    Students must successfully pass all components of the course in order to progress and complete the course.

    Clinical Assessment Sheets (2500 words) – (55%)
    Due Date  –
    CAS A : Week 4 :Friday 28th March 2014 (1000 words)                    
    CAS B:  Week 11, Monday 27 May 2014 (1500 words)
    •    The student will complete 2 clinical assessment sheets.
    •    They will identify and describe a patient that has evidence of clinical deterioration and describe clinical features and indicators of deterioration, following a template provided in their study material.
    •    Each case will focus on specific learning objectives surrounding early recognition and appropriate intervention of unexpected patient deterioration in the areas of:
       - Respiratory and /or  Cardiovascular deterioration
       -  Neurological deterioration

    The assessment sheets are designed so that students directly relate the theory gained within the course to clinical practice in the acute care environment. Students will be required to answer the CAS in relation to patients they care for. A high academic standard is expected. Students are permitted to be creative in how they answer each CAS, using flow charts, concept maps or other to provide their answers.The first assessment will receive feedback prior to week 6 as per University policy.

    Confidentiality
    Patient’s anonymity must be maintained. The use of a pseudonym is required. The pseudonym must also be clearly identified in text. (For example: “Fred (pseudonym) was a 51 year male admitted with an acute exacerbation of chronic obstructive airways disease”). Do not include any other information that may potentially identify the patient or institution, including places, dates, times or events.

    Critique of Practice – (1250 words)    45% (45%)
    Due Date – 
    Discussion Board: Week 8, Monday 9th May 2014
    Critique of Practice: Week 12, Monday 2nd June 2014
    In this assignment the students’ will Choose an appropriate patient story related to the course topics and clinical environment with a focus on the nurses’ role. Students will be required to complete a Critique of Practice utilising a Discussion Board via MyUni with pre-allocated group members in order to select and individually critique ONE episode of unexpected clinical deterioration. Using the Discussion Board students are required to discuss their individual experiences of unexpected clinical deterioration, including interventions and outcomes, and then come to a consensus about which ONE incident from those discussed by the group will be formally critiqued and submitted via individual written assignment.

    It is expected that each student will gain from working collaboratively on the initial discussion surrounding this assignment. Each student will bring his or her clinical experience and expertise from the discussion board collaboration to this assignment, and share their research findings, past experiences and knowledge of current guidelines to:
    a.    Discuss individual experiences of unexpected patient deterioration
    b.    Come to joint consensus on which single incident provides the best opportunity to gain further knowledge on recognition and response to clinical deterioration
    c.    Thoroughly explore all circumstances surrounding the agreed incident, providing evidence of insight and understanding through questions asked
    d.    Develop a systematic outline of specific patient deterioration, actual interventions and recommended interventions based on best practise.
    (NB: sections a to c should be limited to ≤ 250 words in order to meet word requirements for this assignment)

    Combined, these assessments will distinguish the students’ ability to apply a rigorous academic knowledge of the sciences that inform nursing practice in the specialty of acute care nursing.  They will also assess the students’ ability to apply critical thinking skills to problem solving and to evaluate nursing care according to professional standards of practice.    

    Submission
    Assessments, unless otherwise stated in your Study guide, are to be submitted electronically via Assignments in MyUni on the due date identified in this Study guide. Instructions for assignment submission are available for all students under Tutorials at www.adelaide.edu.au/myuni/.
    An assessment submitted via MyUni must be submitted as a .doc, .docx or .rtf file. If submitting a PowerPoint presentation for marking, the .ppt or .pptx must be submitted as .pdf file. It is also important to submit your file under your name, such as surname.firstname. MyUni stamps all the other details against your filename once you submit your assessment.

    An Assignment Coversheet must be submitted with each assessment. The coversheet should be the first page of your assessment. A word version of the Assignment Coversheet is available to download at www.health.adelaide.edu.au/nursing/students/resources. The Plagiarism Statement must be signed and dated for your assessment to be marked (please note the details stated on the Assignment Coversheet). More information on avoiding Plagiarism is available at www.adelaide.edu.au/clpd/plagiarism/.

    If you have difficulty submitting your assignment, you can call the MyUni helpdesk from 8am to 6pm 08 8303 3335.
    Course Grading

    Grades for your performance in this course will be awarded in accordance with the following scheme:

    M10 (Coursework Mark Scheme)
    Grade Mark Description
    FNS   Fail No Submission
    F 1-49 Fail
    P 50-64 Pass
    C 65-74 Credit
    D 75-84 Distinction
    HD 85-100 High Distinction
    CN   Continuing
    NFE   No Formal Examination
    RP   Result Pending

    Further details of the grades/results can be obtained from Examinations.

    Grade Descriptors are available which provide a general guide to the standard of work that is expected at each grade level. More information at Assessment for Coursework Programs.

    Word limit
    You are advised to comply with word limits. You are, of course, not expected to achieve exactly the required length and a 10% leeway on either side is acceptable. However, a penalty of 5% of available marks will apply for word limit in excess of the 10% leeway.

    Presentation
    Your written work must comply with the formatting and referencing indicated in the Student handbook and style guide. Marks will be lost for failing to do so. 


    MARKING GUIDES

    Clinical Assessment Sheets

    Structure and Content    50%
    •    provides concise relevant and accurate patient history
    •    all components of the questions are addressed and covered appropriately
    •    demonstrates application of theory to clinical practice
    •    demonstrates a depth of understanding of the topic and associated significant issues
    •    demonstrates critical thought and insight by providing justification and rationale for answers.

    Writing Style, Presentation and Confidentiality    30%
    Writing Style
    •    the clinical assessment sheet answers are written with clear sentence structure, clarity of argument, precision of expression and the spelling and grammar are correct.
    Presentation
    •    the CAS answers are clearly identified
    •    presentation complies with the School’s Student Handbook and Style Guide.
    Confidentiality
    •    patient anonymity is maintained at all times
    •    the use of a pseudonym must be clearly identified
    •    all identifying features including patient admission dates, URN / hospital id, treating hospital have been excluded.

    Referencing    20%
    •    the referencing style used throughout the paper is congruent with the School’s Student Handbook and Style Guide
    •    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 School’s Student Handbook and Style Guide
    •    the references cited are contemporary (i.e. less than 10 years old unless seminal papers)
    •    primary references are used predominantly (i.e. the original reference has been cited rather than a secondary source)
    •    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
    •    direct quotations are only used to make crucial points or to support the discussion/argument.



    Discussion Board Participation

    Category High Distinction Distinction Credit    Pass    Fail (1)
    Contributions (10%) Posted at least 4 useful ideas when participating in the online group discussion. Posted at least 3 useful ideas when participating in the online group discussion. Posted at least 2 useful ideas when participating in the online group discussion Posted at least 1 useful idea when participating in the online group discussion    No postings of useful ideas when participating in the online group discussion
    Quality of work (20%) Posts/uploads work of the highest quality, integrating a number of current and appropriate references to support inclusions Posts/uploads high quality work using at least three appropriate referecne to support comments Posts /uploads work that is satisfactory with at least tow approporatie references included to support comments Posts/uploads work that is barely satisfactory with at least one appropriate reference to support comments Posts/uploads work that is unsatisfactory with inappropriate or no use of appropriate references
    Level of interaction & responsiveness (30%) Added new comments or responses to most questions; excellent knowledge of issues and/or guided others to resolve problems.

    Exceptional contribution to the social presence of the group.

    Responses are focussed and relevant.
    Added new comments or responses to most questions; showed good knowledge of issues and/or guided others to resolve problems.

    Significant contribution to the social presence of the group.

    Responses are mostly relevant.
    Added new comments or responses to most questions; showed some knowledge of issues and/or guided others to resolve problems.

    Minimal  contribution to the social presence of the group.

    Responses are sometimes relevant.
    Added new comments or responses only to one question

    Contributes minimally to the social presence of the group

    Responses are generally relevant but little elaboration may be offered
    No interaction

    No contribution to the social presence of the group

    Responses undeveloped or unclear
    Critical thinking (30%) Demonstrates excellence in analysing, synthesising and evaluating information and ideas from multiple perspectives.

    Consistently demonstrates the ability to solve problems and argue logically.
    Demonstrates very good proficiency in analysing, synthesising and evaluating information and ideas from multiple perspectives.

    Mostly demonstrates the ability to solve problems and argue logically.
    Demonstrates  proficiency in analysing, synthesising and evaluating information and ideas from multiple perspectives.

    Usually  demonstrates the ability to solve problems and argue logically.
    Demonstrates  adequacy in analysing, synthesising and evaluating information and ideas from multiple perspectives.

    Usually  demonstrates the ability to solve problems and argue logically.
    Demonstrates  deficiency in analysing, synthesising and evaluating information and ideas from multiple perspectives.

    Rarely demonstrates the ability to solve problems and argue logically.
    Clarity of expression & appropriateness (10%) Ideas are clearly organised and developed.

    Language is appropriate for the setting and free of bias.

    Examples are interesting and relevant.
    Ideas are mostly organised and developed.

    Language is appropriate for the setting and free of bias.

    Examples are mostly interesting and relevant.
    Ideas organised.

    Language is appropriate for the setting.

    Examples are sometimes interesting and relevant.
    Ideas may not always flow smoothly.

    Lanugage is not disrespectful or offensive.
    Ideas not focussed or developed.

    Language is questionable or inappropriate.



    Critique of Practice

    Structure and writing style 25%
    Structure (15%)
    •    introduces the patient structure of the study including the occurrence of unexpected clinical deterioration
    •    clearly describes the way in which the critique of practice will proceed
    •    the critique of practice is structured logically with headings used to indicate the sections
    •    the critique of practice summaries the case details and recommendations are made for enhancement of care.
    Writing Style (10%)
    •    the critique of practice is written with clear sentence structure, clarity of argument, precision of expression and the spelling and grammar are correct.

    Content  / Critique 60%
    Content (30%)
    •    the critique of practice has been presented logically
    •    content clearly reveals student knowledge of current guidelines and policies
    •    demonstrates a depth of understanding of the topic and associated significant issues
    Critique (30%)
    •    the critique of practice demonstrates a high degree of critical thought and insight into the patient's condition and nursing care provided by:
    •    providing a justification/rationale for the argument/discussion (or analysis) pertaining to nursing care
    •    demonstrating they have reflected on the complex issues surrounding the nursing care
    •    discussing the nursing care from differing perspectives, thereby providing a balanced argument/discussion.

    Referencing 15%
    •    the referencing style used throughout the assignment is congruent with the School’s Student Handbook and Style Guide
    •    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 School’s Student Handbook and Style Guide
    •    the references cited are contemporary (i.e. less than 10 years old unless seminal papers)
    •    Primary references are used predominantly (i.e. the original reference has been cited rather than a secondary source)
    •    there is evidence in the summary paper that the student has searched widely for information related to the topic/issue
    •    the student has acknowledged all sources of information
    •    direct quotations are only used to make crucial points or to support the discussion/argument.


    Plagiarism
    The University of Adelaide Academic Honesty and Assessment Obligations for Coursework Students Policy & Coursework Students: Academic Dishonesty Procedures policy is available at www.adelaide.edu.au/policies/230/.  Students are reminded that plagiarism and other forms of academic dishonesty constitute a serious offence and can result in disciplinary procedures. Students are advised to read the policy on plagiarism found at www.adelaide.edu.au/policies/230.

    The following processes should be observed:

    Referencing: providing a full bibliographic reference to the source of the citation (in a style as determined by the School).
    Quotation: placing an excerpt from an original source into a paper using either quotation marks or indentation, with the source cited, using an approved referencing system in order to give credit to the original author.
    Paraphrasing: repeating a section of text using different words which retain the original meaning.
    Please note that changing just a few words does not constitute paraphrasing.


    Final results for this course will be made available through Access Adelaide.

  • Student Feedback

    The University places a high priority on approaches to learning and teaching that enhance the student experience. Feedback is sought from students in a variety of ways including on-going engagement with staff, the use of online discussion boards and the use of Student Experience of Learning and Teaching (SELT) surveys as well as GOS surveys and Program reviews.

    SELTs are an important source of information to inform individual teaching practice, decisions about teaching duties, and course and program curriculum design. They enable the University to assess how effectively its learning environments and teaching practices facilitate student engagement and learning outcomes. Under the current SELT Policy (http://www.adelaide.edu.au/policies/101/) course SELTs are mandated and must be conducted at the conclusion of each term/semester/trimester for every course offering. Feedback on issues raised through course SELT surveys is made available to enrolled students through various resources (e.g. MyUni). In addition aggregated course SELT data is available.

  • Student Support
  • Policies & Guidelines
  • Fraud Awareness

    Students are reminded that in order to maintain the academic integrity of all programs and courses, the university has a zero-tolerance approach to students offering money or significant value goods or services to any staff member who is involved in their teaching or assessment. Students offering lecturers or tutors or professional staff anything more than a small token of appreciation is totally unacceptable, in any circumstances. Staff members are obliged to report all such incidents to their supervisor/manager, who will refer them for action under the university's student’s disciplinary procedures.

The University of Adelaide is committed to regular reviews of the courses and programs it offers to students. The University of Adelaide therefore reserves the right to discontinue or vary programs and courses without notice. Please read the important information contained in the disclaimer.