HNB3141: Evidence Based Practice Nursing Health Care Assessment 2

Assessment 2A

Instructions

The assessment piece should be developed using the Australian Commission on Safety and Quality in Health Care standards. Evidence-based practice is applied to develop patient-centred care interventions, using critical thinking and clinical reasoning to explore the patient’s history, presenting problems, and related pathophysiological processes. Adhering to cultural awareness, the nursing standards, code of conduct, code of ethics, and legalities, a holistic care plan is developed by setting specific patient-centred goals and formulating care interventions.

• This is an academic assignment; therefore, academic standards are required, including grammar, sentence structure, paraphrasing, and APA 7th edition referencing for in-text citations and reference lists.
• References must be within ten years, and use as many resources as necessary to support your argument. It is not about how many references you provide; it's how well you support your argument. Referencing is critical for the integrity and quality of your academic writing, and you can seek assistance from the Learning Hub.
• An introduction or conclusion is not required. No dot points. 
• 5 Line spacing
• Font size/style: Arial, font size 12

Case Study

Mr. Smith is a 30-year-old Aboriginal male who was admitted to the hospital due to persistent chest pain that had been ongoing for several weeks, exacerbated by recent episode of flu one week prior. He described the chest pain as sharp, centrally located in the mid-sternal area, radiating to the left side of his back, neck and shoulder, and accompanied with mild dyspnoea. The pain worsened when lying supine and improved when sitting up and leaning forward.

His past medical history includes hypertension, hyperlipidaemia, type 2 diabetes mellitus (T2DM), smoker and obesity, with a Body Mass Index (BMI) of 32. Laboratory results revealed elevated troponin levels and increased inflammatory markers (C-reactive protein (CPR), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count). A physical examination noted pedal oedema, jugular vein distension, and sign of shortness of breath.

Subsequent diagnostic tests, including ECG and echocardiography confirmed a diagnosis of pericarditis with suspected cardiac tamponade and echocardiography revealed a notable pericardial effusion.

Written Assessment

• Refer to the NSQHS third edition for Essential Elements for Recognising and Responding to Acute Physiological Deterioration (National Consensus Statement) and identify and explain four contributing factors for Mr. Smith’s deteriorating condition.
• Using the NSQHS standards and other evidence-based resources, identify and discuss four evidence-based nursing priority care interventions/assessments that can be implemented for Mr. Smith during his hospital stay to prevent the onset of further complications. (Nursing interventions should focus on post-BLS care, not what will be provided during BLS. These interventions may also include nursing assessments. Additionally, it is important to note that cultural care aspects will be addressed in Part B and therefore should not be the focus of this discussion).
• Identify two different validated risk assessment tools utilised by nursing staff that recognise patient deterioration with clear escalation processes embedded. Discuss and critique their effectiveness with supporting evidence. (Think about the validated risk assessment tools that you have observed being used during your nursing/midwifery placement).

Assessment Summary

Assessment Type: Academic Written Assignment (Assessment 2A)

Objective: The assignment requires the student to apply evidence-based nursing practice to develop patient-centered care interventions for a case study patient, using critical thinking and clinical reasoning. The work must align with the Australian Commission on Safety and Quality in Health Care (ACSQHC) standards, nursing codes of conduct, ethical frameworks, and legal requirements.

Case Study Overview:

• Patient: Mr. Smith, 30-year-old Aboriginal male
• Presenting Condition: Persistent sharp chest pain radiating to back, neck, and shoulder; mild dyspnoea
• Medical History: Hypertension, hyperlipidaemia, type 2 diabetes mellitus (T2DM), smoker, obesity (BMI 32)
• Diagnostics: Elevated troponin, inflammatory markers (CRP, ESR, WBC), pedal oedema, jugular vein distension, ECG and echocardiography confirming pericarditis with suspected cardiac tamponade and pericardial effusion

Key Assessment Requirements:

1. Identify and explain four contributing factors to Mr. Smith’s physiological deterioration.
2. Discuss four evidence-based nursing interventions or assessments to prevent further complications (post-BLS focus).
3. Identify two validated risk assessment tools for patient deterioration, with critique on their effectiveness and escalation processes.
4. Adhere to academic standards: APA 7th edition referencing, grammar, sentence structure, paraphrasing, and use of evidence within the past ten years.

Academic Mentor Approach

The Academic Mentor guided the student through a step-by-step structured process to ensure alignment with both clinical and academic expectations:

Step 1: Understanding the Assessment Requirements

• The mentor first explained the purpose of the assignment: developing patient-centered interventions using ACSQHC standards.
• Key learning outcomes were clarified: clinical reasoning, prioritization of care, application of validated tools, and evidence-based intervention planning.

Step 2: Case Study Analysis

• The student was guided to systematically review Mr. Smith’s history, presenting complaints, and diagnostic results.
• Emphasis was placed on connecting the patient’s risk factors and medical history (hypertension, diabetes, obesity, smoking) to his deteriorating condition.

Step 3: Identification of Contributing Factors

• Mentor helped the student list and explain four major factors contributing to deterioration:
  1. Cardiovascular risk factors (hypertension, hyperlipidaemia, obesity)
  2. Diabetes mellitus-related complications
  3. Respiratory compromise from recent flu
  4. Delayed presentation and progression to pericardial effusion/cardiac tamponade
• Each factor was linked to evidence-based literature supporting its role in physiological decline.

Step 4: Development of Evidence-Based Interventions

• Mentor guided the student to select four priority nursing interventions, ensuring they were:
  • Post-BLS appropriate
  • Aligned with NSQHS standards
  • Evidence-based and supported by current research
• Example interventions discussed: continuous monitoring of vital signs, administration of prescribed medications, assessment of fluid status and perfusion, early recognition of worsening cardiac tamponade.

Step 5: Risk Assessment Tools

• The student identified two validated tools (e.g., Modified Early Warning Score (MEWS), National Early Warning Score (NEWS2)) and critically evaluated their effectiveness.
• The mentor encouraged discussion on escalation protocols, accuracy in detecting deterioration, and practical application in clinical settings.

Step 6: Academic Structuring and Referencing

• Mentor reviewed APA 7th edition referencing rules, ensuring evidence was cited from recent sources (within 10 years).
• Guidance was provided on avoiding dot points, maintaining academic tone, and clear paragraph structure.

Outcome Achieved

By following the mentor-guided process, the student produced:

• A cohesive, evidence-based written assignment aligned with NSQHS standards
• Comprehensive identification of contributing factors to deterioration
• Clear post-BLS nursing interventions supported by recent literature
• Critical evaluation of two risk assessment tools with escalation processes
• Academic work adhering to APA 7th edition referencing standards

Learning Objectives Covered:

1. Application of evidence-based practice in patient care planning
2. Development of clinical reasoning and critical thinking skills
3. Understanding and implementation of NSQHS standards for recognizing patient deterioration
4. Ability to critically evaluate risk assessment tools and escalation protocols
5. Academic writing proficiency, including paraphrasing, referencing, and structured argumentation

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