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Maureen is a 76-year-old female, a native of Vanuatu, was brought up with two parents and her three siblings. Maureen’s upbringing was family orientated and she was fortunate to be well educated. Maureen is

ASSESSMENT
INFORMATION

Assessment Title

Assessment
Task 2 – Written Critique

Purpose

This
assessment enables students to articulate an understanding of how theory
translates into care and how evidence underpins best practice within the
palliative approach. 

Due Date

Wednesday
25th October, 2023

Time Due

14:00

Weighting

50%

Submission

Submission
of the assessment task is via the assessment 2 drop box on the NRSG374 LEO
site assessment tile.

Length

2000 words (+/- 10%; includes intext citations
and headings, excludes reference list).

Rubric

Appendix 2 of the NRSG374 unit outline. 

The
assessment will be marked using the criteria-based rubric.

LEO Resource

A national Q&A session will be held during
week seven (7) of the semester via zoom. Students will have the opportunity
to ask the National LIC any questions or clarifications they require. A
recording of the National Q&A session will be made available for
students. All students are recommended to attend this session. The date and a
link for this session is available on the Communication and Support tile on
the NRSG374 LEO site.

Students are encouraged to post questions on
the Assessment 2 Q&A forum on LEO and to check for answers there as a
first point of query.

LOs Assessed

LO1,
LO4, LO6

Task

Students are required to review and critique
the care given in a case study. You are not
critiquing evidence, the CPG, or the standards. The critique of care is
to be based on:

1)    
Contemporary evidence-based literature and

2)    
The End-of-Life Care Clinical Practice
Guideline (CPG) and

3)    
The National Palliative Care Standards and

4)    
The Nursing and Midwifery Board of Australia
(NMBA) standards OR the National Safety and Quality Health Service (NSQHS)
standards.

A critique is not a description of care or the case study. A critique involves
analysing the care, interpreting the care, assessing the care, identifying
positives and negatives (what was done well and not so well and why) and
offering suggestions for improvement.

Students are to critique four (4) episodes of care. These can be
positive or negative elements.

An
“episode of care” is any time that care was provided. This could be an
assessment, a nursing intervention, a referral to another service, or even an
omission of care. Episodes of care can reflect themes, such as communication,
assessment, symptom management, cultural/spiritual needs, family needs
etc. 

Case Study

Background:

Maureen is a 76-year-old female,
a native of Vanuatu, was brought up with two parents and her three siblings.
Maureen’s upbringing was family orientated and she was fortunate to be well
educated. Maureen is multi-lingual and is proficient in English, French,
Bislama and Oceanic. Maureen completed her primary and secondary schooling in
Luganville, Vanuatu. After secondary school, she was awarded a scholarship to
study in Fiji and graduated as a Community Nurse. Maureen worked as a school
nurse in the local Presbyterian school when she returned to Luganville.

Social History:

Maureen met her husband, Peter Jones, an Australian
National whilst working at the school in Luganville. The couple relocated to
Australia after the birth of their first child Mark. Maureen and Peter had
two further children, Karen, and Lisa. The family lived in the suburbs of
Melbourne and made yearly trips back to Vanuatu to visit Maureen’s family.
These family trips continued until the children were young adults. Spirituality:

Maureen is a daughter of a
Presbyterian missionary and consequently was brought up with a strong
Christian faith. Maureen and Peter brought their children up in the Christian
faith and made sure their children practiced not only Christianity, but also
Vanuatu culture and beliefs.

Cultural:

Like Australian Aboriginal
narrative customs, the culture of Vanuatu embraces myths and legends.
Storytelling, songs, and dances are important forms of communications and
form these traditional tales. The story of Vanuatu’s history and landscapes
are at the forefront. Art is a fundamental part of the social life and ritual
celebrations. The Vanuatu culture respect the land and pay homage to the past
and present custodians. Maureen, through inheritance remains a custodian of
the land that her family once owned. This remains very important to Maureen.

Life in Australia:

Whilst the children were young,
Maureen upgraded her qualification from Fiji that enabled her to hold Nursing
registration in Australia. Maureen gained employment at the local Community
Health Centre as a Community Nurse. Maureen initially found it difficult
settling into life in Australia, being away from her family and her local
Presbyterian community. Peter encouraged Maureen to engage in the church
community in Australia. Maureen formed many friendships though the church in
the Melbourne suburbs. Maureen was often volunteering her time at the local
congregation by sharing her love of cooking especially sharing the
traditional dishes of Vanuatu. Maureen’s love of cooking has been passed on
to both her daughters.

When Maureen and Peter retired,
they engaged in more voluntary activities in the Pacific region through
charity organisations and would sometimes spend six months or more in
Vanuatu. The couple funded and helped build a classroom block at the local
Luganville primary school where they had both previously worked. Throughout
Maureen’s life, she has developed a large circle of friends, most of whom
share her love of volunteering. In recent years, due to their age and
increasing health issues, the couple reduced their holidays and travelling
and only visited Vanuatu for special occasions such as family reunions and
funerals.

Past Medical History:

Although Maureen maintained a healthy lifestyle, she was
diagnosed with a peptic ulcer just after Karen was born (1973) for which she
was prescribed a combination

 

of antibiotics, H2 blockers and
proton pump inhibitors (PPI’s) for a 2-month period. This treatment appeared
to work in subsiding Maureen’s symptoms. In 1990,

Maureen was hospitalised with a recurrence of the peptic
ulcer and is now taking a PPI indefinitely to assist with this condition. In
2012, Maureen had a hospital admission following a stroke. The stroke
resulted in moderate left arm and leg weakness. With Peter’s support, Maureen
maintained a reasonable level of functional ability when discharged from
having the stroke. Six years ago, Maureen was diagnosed with Alzheimer’s
disease and was still in the care of Peter.

Maureen also experiences recurrent UTIs, osteoarthritis and
hypertension.

Current Social:

Peter died 2 years ago, following a cardiac arrest. Mark, now
fifty (50) years old, trained and worked as a policeman, however a motor
accident three years ago has left him physically impaired, and wheelchair
bound. Mark lives with his wife Beth and their two sons, in the same suburb
as the family home. Karen, the older daughter and second child is forty-seven
(47) years old and lives in Perth with her husband Ross and their three
children. Karen also has two young grandchildren who reside in Perth. Lisa,
the youngest daughter of Maureen and Peter is forty- three (43) years old,
un-married and has no children. Lisa now lives with Maureen and is her
Financial Enduring Power of Attorney (EPOA) and primary carer.

Admission One:

Four months ago, Maureen had a fall at home, resulting
in a two-week hospital admission. She was discharged into the care of Lisa,
with community nurses visiting twice a week to assist with showering. Maureen
was also provided with a walking stick.

Admission Two:

Five weeks ago, Maureen was admitted to the St Patricks
General Hospital after Lisa found her on the ground in front of the toilet.
Lisa had indicated that she was unsure how long Maureen had been on the
floor. On admission (1400hrs) Maureen’s vital signs were:

RR: 22, HR: 60, BP: 115/68, SaO2: 97% on RA, GCS: 13/15, Temp:
38.2

The registered nurse (RN) looking after Maureen administered
paracetamol. Two hours later, Maureen became agitated and started calling out
for Lisa and speaking in a different language (Bislama). Maureen was also
incontinent of urine, needing a two-assist to mobilise and change her. The RN
provided some reassurance for Maureen, however Maureen continued to call out
for Lisa. Observations were repeated at 1800hrs:

RR: 24, HR: 70, BP: 120/70, SaO2: 97% on RA, GCS: 12/15, Temp:
38.9 Observations were repeated four hours later (2200hrs):

RR: 26, HR: 72, BP: 120/70, SaO2: 97% on RA, GCS: 12/15, Temp:
39.2

At hand over, the afternoon RN reported Maureen’s vital signs
to the night RN. The afternoon RN also indicated that Maureen was calling out
for ‘Lisa’ but the RN didn’t know who ‘Lisa’ was. At this time, the night RN
contacted the on-call doctor to request a review. The night RN obtained a
urine sample and did a dipstick analysis which identified Leucocytes+++ and
Protein++. The night RN reported this to the on-call doctor, who requested a
formal urinalysis and commenced Maureen on oral antibiotics. The night RN
reviewed Maureen’s admission information and identified Lisa to be her carer.
The night RN called Lisa to update her on Maureen’s condition.

The following day Lisa arrived at the hospital to provide
support to Maureen. The urinalysis identified a UTI. Antibiotics and Panadol
were continued. Maureen’s

 

temperature began to fall into
normal range and her agitation reduced.

During Maureen’s admission it
was noted that her cognition was declining, as she was sometimes not
orientated to person/place. Further investigations identified that Maureen
had vascular dementia. Maureen’s capacity for functional improvement
plateaued during her admission and she continued to require 1-2 assist with
all activities of daily living. 

Lisa indicated that she wanted
to continue to care for Maureen at the family home and agreed for extra
services to be put in place to support her. Karen, however, expressed
concerns that Lisa had not been coping well and considering this was
Maureen’s second hospital admission in the past six months, it was now time
for Maureen to enter Residential Care. Karen was highly opposed to Maureen
being discharged home.

After Lisa and Karen had some discussions (without
communicating with

Maureen’s son Mark), it was
agreed that Maureen would be discharged home with Lisa with second-daily
community nurse support. 

At Home:

When at home Lisa found an
Advanced Care Directive that Maureen had completed when Peter was still
alive, which stated that she did not wish to have invasive measures or
surgery if she fell or declined. Two weeks after being discharged home,
Maureen fell, while Lisa was at the grocery store, and sustained a #NOF. 

Admission
Three:

Maureen was admitted to hospital. On
admission, Maureen appeared to be in pain and was requesting to speak to her
church minister. The RN looking after Maureen gave Maureen paracetamol and
contacted the doctor to seek an order for additional analgesia. A full pain
assessment was not conducted as the RN assumed the pain was related to
Maureen’s #NOF.

Lisa requested surgery to repair Maureen’s
#NOF. Karen was opposed to this. At this point
the
interdisciplinary team coordinated a family meeting, including Lisa, Karen,
and Mark, to discuss Maureen’s prognosis and future care. The team
recommended that Maureen be discharged to hospice care due to her cognitive
decline and increasing need for assistance of one to two people to aide with
core tasks associated with daily living.
 

During the family meeting, Lisa
appeared surprised to learn about the prognosis of Alzheimer’s disease and
had difficulty comprehending that Maureen’s condition would deteriorate
further. Lisa admitted that she was having some trouble caring for Maureen
and that Maureen would also frequently start talking in Bislama.

Through the family meeting, it was agreed that Maureen
would be admitted to hospice for her end-of-life palliative care.

Paragraph Structure

The Written Assignment should follow the below
paragraph structure:

Para 1 –
Introduction:
Briefly introduce the case and the condition.
Indicate that you will critique the care provided against high-quality
evidence, the CPG, the National Palliative Care Standards and either (not both) the NMBA or NSQHS
standards. Identify the four (4) episodes of care you will discuss in your
assignment and the sequence of information to be presented – so the reader
knows what to expect in your assignment.

Para 2: Identify the first episode of care you will
critique. Indicate if it was a positive or negative element of care. Identify
why it was positive/negative referring to high-quality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

 

Para 3: Identify
improvements that could have been made in relation to the first episode of care (what should
have been done instead and why?), referring to highquality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

Para 4:
Identify the second episode of
care you will critique. Indicate if it was a positive or negative element of
care. Identify why it was positive/negative referring to high-quality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

Para 5: Identify
improvements that could have been made in relation to the second episode of care (what should
have been done instead and why?), referring to high-quality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

Para 6:
Identify the third episode of care
you will critique. Indicate if it was a positive or negative element of care.
Identify why it was positive/negative referring to high-quality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

Para 7: Identify
improvements that could have been made in relation to the third episode of care (what should
have been done instead and why?), referring to highquality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

Para 8:
Identify the fourth episode of
care you will critique. Indicate if it was a positive or negative element of
care. Identify why it was positive/negative referring to high-quality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

Para 9: Identify
improvements that could have been made in relation to the fourth episode of care (what should
have been done instead and why?), referring to highquality nursing
related/focused evidence, the CPG, the National Palliative Care Standards and
either (not both) the NMBA or
NSQHS standards.

Para 10 – Conclusion:
Summarise what you have discussed in your assignment

(the key
points) and provide your overall critique of the care provided in the case.

Expectations

It is expected that you refer to
high-quality nursing related/focused evidence, the CPG, the National
Palliative Care Standards and
either (not
both) the NMBA or NSQHS standards when critiquing each episode of care.
 

Also, to demonstrate your ability to apply standards into
practice you need to be specific regarding relative standards. For example,
refer to National Palliative Care Standard 1.3, not just Standard 1. Also, do not just list standard numbers
(e.g., This adheres to Standards 1.3, 2.4, 5.1). Listing standards does not demonstrate your knowledge
and understanding of how standards apply to clinical practice. Be specific
and clear regarding the links between the episodes of care you are critiquing
and the standards you apply.

FORMATTING

File Format

.doc or
.docx (Do not submit .pdf files or pages files)

Margins

2.54 cm,
all sides

Font and size

11-point
Calibri or Arial

Spacing

1.5
spacing

Paragraph

Aligned
to left margin, indent first line of each paragraph 1.27cm 

Title Page

Not to
be used

Level 1 Heading 

Centred,
bold, capitalise the first letter of each main word (14-point Calibri or
Arial) It is not mandatory to use headings, however you can if it will assist
you e.g.

Introduction

Episode of Care 1

Episode of Care 2

Episode of Care 3

Episode of Care 4

Conclusion

Level 2 Headings 

Not to
be used 

Structure

Introduction,
main paragraphs, conclusion, reference list

Direct quotes

Always require page number. No more than 10% of word count in direct
quotes 

Header 

Page
number top right corner (9-point Calibri or Arial) 

Footer

Name –
Student Number – Ax2 – NRG374 – 2023 (in 9-point Calibri or Arial)

REFRENCING

Referencing Style

   APA 7th
edition                    

Please
refer to the
ACU APA7 Referencing guide for detailed information and resources.

Minimum References

A minimum of 18 high quality nursing related/focused resources are to
be used. All arguments must be supported using a variety of high-quality
primary evidence.

Avoid
using any one source repetitively.

Age of References

Published
in the last 5 years unless using seminal text.

List Heading

“References”
is centred, bold, on a new page. (in 14-point Calibri or Arial)

Order

References
are arranged alphabetically by author family name.

Hanging Indent

Second
and subsequent lines of a reference have a hanging indent.

DOI

Presented
as functional hyperlink.

Spacing

1.5
spacing the entire reference list, both within and between entries.

Referencing the CPG & Case

You do not need to reference the case study.

Please
ensure you reference the CPG (ACU, 2021) throughout your assignment and in
the reference list. These can be referenced following APA7 referencing
style. 

ADMINISTRATION

Late Penalties

Late penalties will be applied from 14:01 pm
on the due date, incurring 5% penalty of the maximum marks available up to a
maximum of 15%. Assessment tasks received more than three calendar days after
the due or extended date will not be allocated a mark.

     Penalty Timeframe                                         Penalty             Marks Deducted

 

14:01
Wednesday to 14:00 Thursday

5%
penalty               5 marks

 

14:01
Thursday to 14:00 Friday

10%
penalty             10 marks

 

14:01
Friday to 14:00 Saturday

15%
penalty             15 marks

 

Received
after 14:00 Saturday

No mark allocated

 

Example:

An assignment is submitted 12 hours late and
is initially marked at 60 out of 100. A 5% penalty is applied (5% of 100 is 5
marks). Therefore, the student receives 55 out of 100 as a final mark.

Return of Marks

Marks and
feedback will be returned electronically via Turnitin. Marks will be withheld
until after grade ratification and grade release.
 

Academic Integrity

       
Academic integrity will be monitored in all
assessments submitted.

       
Use APA7 referencing style and paraphrase
adequately.

       
Turnitin monitors the use of artificial
intelligence. 

       
Be sure to submit your own work.

       
Submit your assessment with enough time to
obtain your similarity report from Turnitin and review your citations and
paraphrasing to see if they need to be improved.

Extensions

All extension request forms need to be submitted
electronically to the extension application drop box on the
NRSG374
LEO site on the ‘Assessment’ tile.

This should normally occur at
least 24 hours before the due date and time as per
ACU Assessment Procedures Section 2 Student Responsibilities. If submitting within 24hrs of the prescribed due date/time –
the exceptional circumstances must have arisen with the 24hrs leading up to
the due date/time.  

There is no need to email the LIC to notify them you have
submitted an extension request.
The extension request drop box
is checked Monday to Friday during normal business hours for new extension
requests. Staff will only review applications received in office hours and
not on a public holiday. 

If your EIP contains provisions for extension to assessment
tasks you must still, follow the standard university procedure to apply for
an extension. If your reason for seeking an extension is unrelated to the
condition identified in your EIP, you may be required to provide evidence of
your circumstances. 

Special

Consideration

If you cannot complete an
assessment due to difficult circumstances, you may be eligible for special
consideration. Before completing a
Special Consideration Form, make sure you are familiar with the criteria and processes. 

Special consideration request
forms for a single unit (NRSG374) need to be submitted electronically to the
special consideration application drop box on the
NRSG374
LEO site on the ‘Assessment’ tile. 

If applying for special
consideration across multiple units, the special consideration form needs to
be forwarded to your Course Coordinator for review.

Special consideration for one assessment task cannot be
submitted before the

 

assessment due date and can only be submitted up to five
working days after the relevant assessment due date.
  

Assessment template project informed by ACU
student forums, ACU Librarians and the Academic Skills Unit.

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