NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 2: Project © Australian Catholic University 2023 _ Page 1 of 4
ASSESSMENT INFORMATION
Assessment
Title Assessment Task 2 – Project
Purpose This assessment enables students to demonstrate sound understanding of the application
of professional nursing standards, national health standards and organisational policy
elated to patient deterioration and a sentinel event.
Students are given the opportunity to complete a root cause analysis (RCA) for one of two
provided case study options.
Due Date Wednesday 19th April 2023
Time Due 14:00
Weighting 40%
Length Equivalent to 1600 words +/- 10%
Assessment
Ru
ic Appendix 1 of the NRSG378 unit outline
LEO
Resource
A national pre-recorded video will be uploaded onto LEO in week five (5), which will provide
students with an overview of the assessment as well as resources and advice on how to
approach the task.
Students are encouraged to post questions on the discussion forum on LEO and to check
for answers there as a first point of query.
LOs
Assessed LO1, LO2, LO3, LO5
Task
Students will complete a root cause analysis (RCA) using a provided template.
You will choose from either ONE of two case studies below to complete a RCA, and you will
e required to respond to the following sections:
1. Provide a
ief description of the event
2. Identify and discuss the root causes which have likely contributed to the sentinel
event
3. Identify and discuss at least two (2) NMBA RN Standards which were not practiced
or maintained by the nurses involved in this sentinel event, that may have led to the
identified root causes.
4. Discuss at least two (2) National Safety and Quality Health Service (NSQHS)
Standards which were
eached (or not met) by this health organisation, that may
have led to the identified root causes.
5. Outline a minimum of three (3) recommendations to address the root causes
identified from the chosen case study. These recommendations need to include
practical examples and identify who is responsible for actioning these
ecommendations.
NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 2: Project © Australian Catholic University 2023 _ Page 2 of 4
Case Study
Option 1
Case Study One
A 79-year-old patient, Mrs Sergi was admitted to hospital for a routine hip replacement. Mrs
Sergi had been experiencing hip pain for a few years and was alert and oriented before
surgery, although she was noted to be frail and weighing 35kg.
The operation was performed at the start of the afternoon operation list and her surgery
was uneventful. Mrs Sergi had a PIVC inserted in OT and the medications chart recorded
that she had received 500mls of NaCl 0.9% IV intraoperatively. At the conclusion of the
operation the Anaesthetist commenced a new 1L IV bag of NaCl 0.9% and ordered IV NaCl
0.9% over 10 hours x 2 bags (100 ml/hour), until the patient’s review the following day.
Mrs Sergi was transfe
ed to PACU at 3pm into the care of the PACU team and a PACU
observations chart was commenced. Mrs Sergi was soon alert and oriented and
communicating coherently with PACU staff and her observations were all within normal
limits and her pain well controlled. At handover to the ward nurse (Fiona), the PACU nurse
mentioned that the anaesthetist wanted Mrs Sergi to have ‘as much fluid as possible’, so
Fiona wrote this on the observation chart.
On RTW at 4pm Fiona settled Mrs Sergi into the ward and commenced a fluid balance
chart and wrote “as much fluid as possible” in this chart too. She set up the IV pump at
200mls/hr and commenced hourly post-op obs. The ward got busy that evening and only 1
set of observations were recorded in Mrs Sergi’s chart. At handover to night staff at 9.30pm
Fiona reported that Mrs Sergi had “obs within normal limits except for an elevated BP, and
lowish pulse and a bit of a post-op cough, to have as much fluid as possible and her IVT
needs a new bag as charted”.
The Night nurse (Tanya) checked Mrs Sergi’s IVT at 10pm and commenced a new 1L bag
of NaCl 0.9% at 200 ml/hr and noted that the patient was short of
eath and confused, so
she recorded this in the patients chart as “confused ?? dementia” and continued with her
shift. At 3am Tanya went to change the IVT bag and noticed that Mrs Sergi was extremely
short of
eath and very agitated, so she called the on-call Dr for a non-urgent review. The
Doctor came to the ward at 4am and found Mrs Sergi unresponsive. A MET call was
initiated but Mrs Sergi could not be revived and was declared deceased at 4.30am.
Scenario adapted from Staunton, P. and Chiarella, M., 2012. Law for nurses and midwives.
Chatswood, N.S.W.: Elsevier Australia.
NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 2: Project © Australian Catholic University 2023 _ Page 3 of 4
Case Study
Option 2
Case Study Two
Mr Evans, a 45-year-old man presented to a small regional hospital Emergency Department
with a laceration to his leg caused by an accident with farming equipment, and dehydration
due to delays in calling for help. His laceration was cleaned and sutured, and he was
ehydrated with IV fluids with good effect but he experienced some mild nausea. The doctor
ordered 5mg of IV metoclopramide for nausea, and 1g of oral paracetamol for pain as a
STAT dose before discharge.
The nurse on duty, Lorna, was a registered nurse with 40-years’ experience, and was the
Assistant Director of Nursing at the hospital. However due to staff absences, she was
helping in the ED for the shift. Lorna had not worked clinically for many years, but she
wanted to support her staff.
She introduced herself to Mr Evans and he asked about having his medications because he
wanted to go home as soon as possible. Lorna read the medication chart, but she felt
unsure about administering the medications, so she consulted with experienced ED nurse,
Ba
y, who said that he’d prepare the medications for her even though he was very busy.
Ba
y read Mr Evan’s medication chart and prepared the IV metoclopramide and noting that
the patient would possibly not tolerate tablets due to nausea, he drew up 1g of oral
paracetamol elixir liquid into a syringe and put both syringes in a tray. He then gave the tray
to Lorna and continued his shift.
Lorna noticed that both medications were in syringes, and she assumed both were for
injection. She was unaware that paracetamol could be given via IV route so she asked a
passing nurse (Kate), “can paracetamol be given IV? and Kate replied “yes”. Lorna
proceeded to give both medications into Mr Evan’s IV cannula. Mr Evans immediately
developed symptoms of a pulmonary embolus, which proceeded to a massive stroke, and
he was declared deceased after 30 minutes of resuscitation attempts.
Scenario adapted from Staunton, P. and Chiarella, M., 2012. Law for nurses and midwives.
Chatswood, N.S.W.: Elsevier Australia.
Submission Via the Turnitin dropbox in the NRSG378 LEO site under the “Assessment” tile.
NRSG378: Principles of Nursing - Extended Clinical Reasoning
NRSG378_ Assessment 2: Project © Australian Catholic University 2023 _ Page 4 of 4
FORMATTING
File format The assessment will be completed using the provided RCA template available
on LEO under “Assessment 2” in the “Assessment” tile, or via this link.
There is no need to include an introduction or conclusion.
Each answer must be cited and supported by a wide range of relevant and
credible resources.
The assessment will be submitted as a Microsoft Word document file via
Turnitin. Please do not submit pdf files.
REFRENCING
Referencing Style APA 7th edition
Minimum References
A minimum of 15 high quality 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.
Alphabetical Order References are a
anged alphabetically by author family name
Hanging Indent Second and subsequent lines of a reference have a hanging indent
DOI Presented as functional hyperlink
Spacing Double spacing the entire reference list, both within and between entries
ADMINISTRATION
Late Penalties
Late penalties will be applied from 2:01pm on the due date, incu
ing 5% penalty
of the maximum marks available up to a maximum of 15%. Assessment tasks
eceived more than three calendar days after the due or extended date will
eceive feedback but will not be allocated a mark.
Penalty Timeframe Penalty Marks
Deducted
2:01pm Wednesday to 2pm Thursday 5% penalty 5 marks
2:01pm Thursday to 2pm Friday 10% penalty 10 marks
2:01pm Friday to 2pm Saturday 15% penalty 15 marks
Received after 2:01pm 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
eceives 55 out of 100 as a final mark.
Return of Assignment
Marks will generally be returned within three weeks of the submission due date;
if there are any changes you will be notified via the LEO announcements.
Assessment template project informed by ACU student forums, ACU Li
arians and the Academic Skills
Unit.
https:
leo.acu.edu.au/mod
esource/view.php?id=4666233
NRSG378 Extended Clinical Reasoning – Assessment 2 Project
Root Cause Analysis Report - Template
INSTRUCTIONS:
Please use this template to complete assessment 2. You are required to respond to only ONE of the provided case studies. You need to indicate which case study you have chosen in the first section.
Your discussion must be cited and supported by a wide range of relevant and credible sources for each section. You are required to include a final reference list at the end.
1. Description
Identify which case study you have chosen (1 or 2), and provide a
ief description of the event and the outcome for the patient. (100 words)
2. Identification of root cause and contributing factors
Identify one (1) root cause and discuss at least three (3) contributing factors which have likely caused this sentinel event.(200 words)
3. Links to NMBA RN Standards for Practice
Identify and discuss at least two (2) NMBA RN Standards which were not practiced or maintained by the nurses involved in this sentinel event, that may have led to the identified root causes. (350 words)
1
2
4. Links to National Safety and Quality Health Service (NSQHS) Standards
Identify and discuss at least two (2) NSQHS Standards which were
eached (or not met) by this health organisation, that may have led to the identified root causes. (350 words)
1
2
NRSG378: Extended Clinical Reasoning
NRSG378_ Assessment 2: Project RCA Template © Australian Catholic University 2023 _ Page 1 of 6
5. Recommendations
Outline a minimum of three (3) recommendations to address the root causes identified from the chosen case study. These recommendations need to include practical examples and identify who is responsible for actioning these recommendations. (600 words)
(NOTE: you can add more rows if required – right click on the last row of the table, “insert”, “insert row below”)
Recommendations to address root cause
Practical example(s) to achieve recommendations
Position responsible/ accountable
1
2
3
Reference List (APA 7th edition format)
APPENDIX 1 - ASSESSMENT 2 PROJECT
Total marks - 100, Weighting - 40%
Ctr 0 E5100) EET) Exe) EC) EE) No Adem
(weighting)
Tdentication of | Faciors which have edo | Factors whi vee | Factors whit have ed | Factors whch fave eo | Doss nt defy acs | Doss rt dey
Tactorsleadnato | sarin event sr cried and | ro satel entare | th saat evant are | a satel vent are | wich nave ado ma | ars when
Sennett Compranarsweh raised | Harthes ans arcumied | erat and ipso | Hert ans supa | sonnel ser: Te ado he
or semi sats 8 | and susan oy arange | bv mostly rede | bv soma rads Deon ort Sonne ven
. rie ran teeta and | of teva and crane” | as Son ie | Sesion oret
code sauces. sources. ov Sioponedty any
te u
Like to NMBARN | Approiatel etfs t ast | Appraptay denies a erie cerien a | Dose ra cen a east | Doss ot erty
Stanaardator an Sarason | la wa) lm teo RN reo $2) AN Samar | any RN Stars
Pracics Pracics win canprenersve | Sundar x Practica | Sardar x Prac | Sanders ot Prac | Pacis, cr doesnt | or prac. ana
Iocan ant soba | i rug caion | ih son fesion | wi bas scaion | provide canon, oc | doesnot prov
wo Cone sy inks one case | atin iohecass | ales acess | ovinkedio cme. | hemos anais
corso a suppototbya |