NRSG378 - Principles of Nursing: Extended Clinical Reasoning

Year

Credit points

Campus offering

Prerequisites

NRSG264 Integrating Practice 3 and NRSG265 Principles of Nursing: Medical and NRSG267 Integrating Practice 4

Unit rationale, description and aim

Effective clinical reasoning is a hall mark of Registered Nurse practice in all clinical environments. Registered nurses use methodical and consistent thought processes to; consider the specific aspects of each presenting situation, determine what cues and further information is required, process the information to identify problems, establish goals and determine course of action, evaluate outcomes and reflect on new learning. To achieve effective clinical reasoning communication with patients, family and the members of the nursing and interdisciplinary health team is essential. 

This unit will assist students with their ongoing development of theoretical knowledge underpinning provision of nursing care for the person, family and significant others who are experiencing acute deterioration of health. Key principles that underpin best practice will be demonstrated by the use of evidence-based case studies. The nurse’s role in the provision of care for the person experiencing an acute clinical deterioration will be explored across a variety of settings and patient journeys within the context of interdisciplinary care. The content contained within this unit is instrumental in informing nursing students’ future clinical practice across a variety of settings.

The aim of this unit is to support students to extend and consolidate their development of clinical reasoning skills so that they can provide person-centred, evidence based nursing care of individuals experiencing acute deterioration of health. Most importantly this unit will consolidate students understanding of the fundamental clinical reasoning skills to improve patient outcomes and limit harm and adverse events in their chosen health care settings.           

Learning outcomes

To successfully complete this unit you will be able to demonstrate you have achieved the learning outcomes (LO) detailed in the below table.

Each outcome is informed by a number of graduate capabilities (GC) to ensure your work in this, and every unit, is part of a larger goal of graduating from ACU with the attributes of insight, empathy, imagination and impact.

Explore the graduate capabilities.

On successful completion of this unit, students should be able to:

LO1 - Relate the care for individuals experiencing an acute deterioration of health, using a comprehensive knowledge of pathophysiology to the implementation of clinical reasoning and decision making (GA4, GA5)

LO2 - Implement critical thinking and clinical reasoning across the life span and a range of settings, to plan safe, evidence-based, culturally sensitive, person-centred nursing care for a person experiencing an acute deterioration in health (GA3, GA4, GA5, GA8, GA9)

LO3 - Explain the principles and practices of quality use of medicines at a third year undergraduate level (GA1, GA3)

LO4 - Apply ethical, legal, cultural and professional principles at a third year undergraduate level (GA3, GA5)

LO5 - Critically apply the principles of teamwork, delegation and self-management when planning, implementing and evaluating patient care and/or clinical responsibilities for a person experiencing an acute deterioration of health (GA7)

Graduate attributes

GA1 - demonstrate respect for the dignity of each individual and for human diversity

GA3 - apply ethical perspectives in informed decision making

GA4 - think critically and reflectively 

GA5 - demonstrate values, knowledge, skills and attitudes appropriate to the discipline and/or profession 

GA7 - work both autonomously and collaboratively 

GA8 - locate, organise, analyse, synthesise and evaluate information 

GA9 - demonstrate effective communication in oral and written English language and visual media 

NMBA Registered Nurse Standards for Practice

The Nursing and Midwifery Board of Australia’s Registered Nurse Standards for Practice developed in this unit are:

Content

Topics will include:

Review of underpinning pathophysiology of:

• Respiratory function
• Inflammatory processes
• Cardiovascular function
• Psychosis
• Stress diathesis

Principles of managing a person with acute deterioration:

• Recognition of a person with acute clinical deterioration
• Assessment and monitoring
• Early warning scores
• Diagnostic procedures
• Risk factors and comorbidities
• Person centered focus
• Biopsychosocial, spiritual and cultural considerations for the individual
• Therapeutic communication with person and significant others
• Professional communication and collaboration in the interdisciplinary team
• Responding to a person with acute deterioration of health
• Nursing Actions
• Evaluation
• Reassessment
• Escalation of care
• Emergency Codes 
• Health care team
• Patient and family escalation of concerns
• Setting goals
• Continuity of Care
• Quality use of medicines
• Discharge Planning
• Documentation
• Legal and ethical Issues

Clinical Reasoning for the patient with acute deterioration:

• Clinical reasoning for people with acute deterioration of respiratory function, their relatives, significant others and carers
• Asthma
• Acute Lung Injury/Syndrome
• Pulmonary Embolism
• Clinical reasoning for people with acute deterioration of cardiovascular function, their relatives, significant others and carers
• Acute Heart failure
• Cerebral-Vascular accident
• Clinical reasoning for people with acute deterioration related to Shock, their relatives, significant others and carers
• Hypovolaemic shock
• Septic shock
• Clinical reasoning for people with acute alteration of mental health/cognition, their relatives, significant others and carers.
• Acute psychotic episode
• Impairment from alcohol/drug
• Delirium
• Impact of hospitalisation on psychological state
• Anxiety/sleep/pain

Regulatory frameworks:

• National Health Standards
• National Safety and Quality Health Service Standards
• Professional
• National Board: Nursing and Midwifery Board of Australia (NMBA)
• Registered Nurse Standards for Practice, Codes & Guidelines
• Organisational
• Continuous quality improvement
• Organisational environment 

Learning and teaching strategy and rationale

Modes of delivery in this unit include lectures, tutorials, online activities and self-directed study. Consistent with adult learning principles, the teaching and learning strategies used within these modes of delivery will provide students with foundational knowledge and skills relevant to professional nursing practice. These strategies will also support students in meeting the aim, learning outcomes and graduate attributes of the unit and the broader course learning outcomes. Learning and teaching strategies will reflect respect for the individual as an independent learner. Students will be expected to take responsibility for their learning and to participate actively with peers.  

Students at university need to operate effectively as self-sufficient learners who drive their own learning and access the learning supports they require. To guide students in their learning, feedback is required to identify what is being done well, what requires additional work and to identify progress toward required learning outcomes. Located in the third year of the programme, this theory unit includes face-to-face teaching hours and an increasing online component of learning to build life-long learning skills. Online recorded lectures are utilised to convey content and central principles while tutorials provide an opportunity to consolidate students’ understanding of content through collaboration and discussion. Tutorials deliver interactive and student-driven learning sessions which require an increasing reliance on students to extend their community of learners and increase self-reliance. Online materials provide students with the opportunity to undertake directed, self-motivated study and continue to transition to independent study and life-long learning.

Optional formative online quizzes will be made available to students prior to week 4 of semester to provide feedback on their progress and guide their unit learning. A summative quiz will be provided mid-semester as an early low stakes assessment item.

This unit may be offered on or off campus in intensive mode for sponsored / special cohorts, with the learning and teaching strategies being equitable with on campus mode offerings as endorsed by the Discipline Curriculum Implementation Committee. 

Assessment strategy and rationale

A range of assessment items consistent with University assessment requirements and policy will be used to ensure students achieve the unit learning outcomes and attain the graduate attributes. 

In this unit, there are three assessment items, these assessments are required to build student knowledge and skills which, by the conclusion of this programme, will enable the student to graduate as a safe and effective nurse.

Students will complete a project that will enable them to analyse the issues that enable or detract nurses and interprofessional health care teams when responding to the acutely deteriorating patient. The final assessment task requires students to build upon the knowledge and skills developed in previous years and this semester, to apply critical thinking and clinical reasoning to a complex and authentic case study. Students will use critical thinking and clinical reasoning to make sound clinical decisions that are in alignment with evidence based literature and nursing and health care professional standards of Australia. 

Off campus intensive assessment of this unit will be transparently equitable with on campus mode offerings as endorsed by the relevant Course Implementation Committee.

Overview of assessments

Representative texts and references

Brown, D., Edwards, H., Buckley, S., Aitken, R. (2020). Lewis’s medical-surgical nursing. Assessment and management of clinical problems (5th. Ed). Elsevier.

Bullock, S. & Hales, M. (2019). Principles of pathophysiology (2nd ed.). Pearson.

Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology. (8th ed.). Pearson. 

Forbes, H., & Watt, E. (2020). Jarvis’s physical examination and health assessment (3rd ed.).Elsevier

Holland, K., Jenkins, J., Solomon, J., & Whittam, S. (2019). Applying the Roper-Logan-Tierney Model in practice-E-Book. Elsevier. 

Levett-Jones, T. (2017). Clinical Reasoning: Learning to think like a nurse. Pearson.

Tiziani, A. P.(2021).Havard’s nursing guide to drugs(11th ed). Elsevier.

Tortora, G.T., Derrickson, B.H., Burkett, B., Peoples, G., Dye, D., Cooke, J., Diversi, T., McKean, M., Samalia, L., & Mellifont, R. (2019). Principles of anatomy and physiology (2nd Asia-Pacific ed.) John Wiley & Sons,