NRSG374 AT1 - Marking Guide Student Version

General information provided to students

Appropriate sources
Relevant to nursing does not mean it must be a nursing journal, its means that the content and context is appropriate for use by nurses. This can include a range of medical and allied health content.
Primary sources over secondary sources, most secondary sources will be deemed not suitable for the assessment, this includes websites like Care Search and PCC4U. Use these sites as the starting point they can help direct you to appropriate sources of topics. They are not the source you reference.

About Alex
The case study does not specify a gander or age for Alex; the student can choose to assign these. If they do so they should be clear and consistent with this.

Criteria Anatomy and physiology 

Addresses questions

1. General overview of pathophysiology of bony metastasis. From the pathophysiology identify common signs and symptoms on bony metastasis.
2. A targeted pathophysiology of main causes of pain in bony metastasis.

Guidance given to students

Students have been advised that they are not to separate the pathophysiology from the signs and symptoms. There needs to be a clear connection between the two. They should discuss A&P which results in the following sign or symptom. And repeat. It is ok for the pain component to be embedded in this section and discussed together or they can have a separate discussion on pain. As long as the A&P mechanisms of pain are clearly discussed.
Students who want the top marks have been advised to provide a rationale for why they have chosen to discuss particular S&S (based on most common) and the highest end would demonstrate understanding of S&S impacting quality of life and EOL – this is a key way to link Alex into the discussion.

How to score

If there is no link between the A&P and the S&S then they will score in the NN range. To be in the pass range they must at least link A&P and Pain and A&P and one other S&S and the information must be factually correct.
D and HD grades will address at least pain and 3 other common S&S. Plus the comments above about rationale for chosen S&S. Note that while it is good to link to the case study it is not a requirement of this criteria.
Credible sources for this section do not need to be nursing specific – therefore recent A&P textbooks or articles might suit. Alternatively, articles that are specific to the topic would be suitable.
Not suitable sources would include websites (including hospital or health organisation websites – as these are secondary sources), blogs, video’s. I recognise that textbooks are secondary sources however the peer review process still occurs.

Criteria Pain assessment 15 marks

Addresses question: Discuss how you will conduct a pain assessment, including appropriate pain assessment tool, on Alex given their current condition. Back your recommendation up with credible evidence.

Guidance given to students

Need to be comprehensive - PQRST does not cut it. Focus beyond the physical, link back to QOL. Meeting goals preferences and values.

Expected responses

Student should demonstrate the need for comprehensive assessment. The best way to approach would be to start with a general assessment strategy for a holistic approach. Then use an appropriate targeted pain assessment.

How to score

If the strategy recommended by the student is not appropriate then they need to be marked NN for the criteria. The response should contain the following

1. Choice of appropriate strategy
2. Strategy is supported by demonstrating that the student understands a) Alex’s condition and their ability to participate in pain assessment and, b) appropriate sources of information
3. Students will achieve higher marks if they are able to outline HOW to undertake the assessment – thereby demonstrating application of knowledge

Criteria Pharmacology recommendation 10 marks

Addresses question: What recommendations will you make to the Medical Officer regarding pharmacological options best suited to Alex’s current condition and diagnosis. Back your recommendations up with evidence.

Guidance given to students

This should be clearly a recommendation – what would they advocate for on behalf of Alex. In the discussion forum we identified that the type of medication and mode of delivery are the most important. There is no expectation of dosage amounts as medication titration of medications (particularly of opioids) are beyond our expectation currently.
No more than 2 or 3 medications - importantly why did they preference or prioritise the ones you choose. Should be driven by the evidence and link to mechanism of pain from A&P.

How to score

Any medication advised that is ‘not relevant to the person’s condition’ should receive a NN grade.
Key points to determine the score include

1. Appropriate medication choice
2. Appropriate mode of delivery
3. How have they justified their case? And with what evidence. Supporting evidence should be sources that are relevant to context and condition.

Criteria non-pharmacological care 20 marks

Addresses question: What non-pharmacological nursing actions will you take to help alleviate the pain – discuss two (2) of these in depth and support with evidence

Guidance to students

Need to focus on pain and mechanism of pain. Specified 2 – justify why you have selected these two. They need to be nursing interventions, while they may have a component of referral to MDT the core intervention must be nursing specific. Just referring to another MDT member is not a suitable response to this question.
Other than the assessment provided in Appendix B the students have the latitude to make assumptions about Alex which they then address, they have the flexibility to add details to the case study, as long as they are consistent throughout the presentation.

How to score

10 marks for each intervention. If the intervention is not suitable to Alex’s current condition, then NN grade for that intervention, even if there is a clear discussion on how to apply and supporting evidence. For each intervention has the response included

1. Clear identification of a nursing specific intervention – if not they are to receive less than 5 marks for the intervention, regardless of the discussion on how to do it and the supporting evidence.
2. The context of the assessment is educating peers, as such they should provide detail on how to undertake the intervention.
3. Supported with suitable evidence as per general guidance.

Criteria Applying RLT model 10 marks

Addresses question: Using the Roper Logan Teirney model discuss lifespan and sociocultural factors as they may apply to Alex include how nurses use this knowledge to apply person-centred care (see chapter 14 in the text Applying the Roper-Logan-Tierney Model in Practice, available through the Canvas reading list for support).

Guidance to students

Purpose of the assessment is giving information to your peers. Demonstrate understanding of how lifespan and sociocultural impact on palliative journey. Students have two choices they can

1. Discuss in general how the stage of person is at in life and their sociocultural circumstances can impact QOL and palliative experience, OR
2. Student can assign an age and gender to Alex and apply the lifespan and sociocultural factors specific to these details.

Most importantly is the need to demonstrate how nurse use this knowledge to provide appropriate person-centred care.

How to score

There are three parts to this question the student needs to demonstrate understanding in

1. What lifespan and sociocultural factors are
2. How understanding of these factors are applied to create person-centred care.
3. The response is supported by appropriate evidence. In this case at least one reference must directly support RLT model of care as this is specified in the question as the model to be used.

Criteria Applying Doctrine of Double effect 10 marks

Addresses question: Explain the doctrine of double effect. What application does this have in nurses’ clinical decision-making regarding Alex’s care?

Guidance to students

What it is and how it sits within Australian Law (state specific). Students were guided to the End-of-life-law resource Specifically Module 6: Legal protection for administering pain and symptom relief. Further information here
Students must address this from a least a legal perspective although some may add an ethical component.

How to score

The student must discuss the legal foundations of the DDE AND how this informs decision making, appropriated supported, in order to pass this criterion.

• The legal underpinnings are discussed – ideally as applicable to a state. Students must make clear which state/territory they are aligning their discussion with and stay consistent.
• Application to practice, the student should provide guidance on not just the principle that DDE supports choices such as analgesics at End-of-life, but also what requirements the nurse needs to ensure are present for the DDE to be in effect.

Criteria Intro and Conclusion 10 marks

Guidance to students

The introduction needs to

• Introduce themselves
• Outline the purpose of the session and the key learning outcomes

The conclusion needs to

• Summarise the key learning points – the content not just name the topics
• Either in the summary or separately link back to the key learning outcomes identified in the introduction

 

Guidance to students

Students have been advised that they are addressing other graduate nurses. Therefore, they should use appropriate terminology. General nursing terms and acronyms like ADL’s and MDT can be used straight away as these are generally accepted terms. Palliative specific terms such as EOL or PCOC should be laid out in full for first use and thereby build their peers language knowledge of palliative terms.
No paragraphs on slides – need to meet a balance between good presentation standards (minimal or key words/phases visually appealing) and academic need for clarity about where information has come from (referencing). Students have been advised that they can verbalise 1 or 2 references that are not listed on the slides. However, it should be clear within the sentence the reference is used what content it relates to. Verbalisation of refence only is the exception. The reference must still be included in the reference list
Students have a maximum of 16 min 30 seconds total talking time. If this is exceeded do not mark any oral information after this time.

Criteria Referencing 5 marks

Students are expected to reference according to APA7 – The ACU library guide is here.
There is a section on images in the guide. As a rule the image on the slide will start with Note. 

Example guidance from the guide of image from a textbook
Note. From Entity-Oriented Search (p. 190), by K. Balog, 2018, Springer
(https://uis.brage.unit.no/uis-xmlui/handle/11250/2581845). Copyright 2018 by K. Balog.

Notes

• Provide copyright attribution in the note, then provide a reference list entry for the book in the reference list. (note for markers that this reference may be the same for both an image and an intext reference)
• Double space the note and align left. (This may not be suitable for PowerPoint slides. The most important part is that the correct attribution information is present rather than its alignment on the slide).

What you must cover

• Appropriate sources: Privilege primary, peer-reviewed evidence (A&P texts/articles acceptable). Avoid general websites/blogs as main sources; follow APA 7 with correct image attribution notes.

• About Alex: You may assign age and gender—be explicit and keep details consistent throughout.

• Anatomy & Physiology (A&P) of bony metastasis (15 marks):

  • Explain pathophysiology and directly link each mechanism to specific signs & symptoms (S&S) (do not separate them).

  • Include a targeted explanation of pain mechanisms in bone metastasis.

  • Aim higher by justifying why you prioritized particular S&S (prevalence/impact on QoL/EOL).

• Pain assessment (15 marks):

  • Use a comprehensive, holistic approach (beyond PQRST), aligning with Alex’s condition, goals, values, QoL.

  • Select and justify an appropriate tool, show how you would conduct the assessment, and identify information sources (patient, family, records).

• Pharmacology recommendations (10 marks):

  • Recommend 2–3 suitable medications and modes of delivery aligned to the pain mechanisms (no dosages required).

  • Justify choices with context-relevant evidence.

• Non-pharmacological nursing care (20 marks):

  • Discuss two nursing-specific interventions (not just referrals) in depth, justified by pain mechanisms.

  • Explain how to perform each intervention and support with evidence.

• Applying the Roper-Logan-Tierney (RLT) model (10 marks):

  • Discuss lifespan and sociocultural factors (either generally or for your stated Alex profile) and show how nurses use this knowledge to deliver person-centred care.

  • Include at least one source directly supporting the RLT model.

• Doctrine of Double Effect (DDE) (10 marks):

  • Explain DDE and its legal basis in Australia (state/territory specified and consistent).

  • Show how it guides nursing decision-making (requirements for its application).

• Intro & Conclusion (10 marks):

  • Intro (5): introduce yourself, state purpose and learning outcomes.

  • Conclusion (5): summarize key learning points (content, not just headings) and link back to the learning outcomes.

• Presentation (5 marks): Professional language for graduate nurses; expand palliative acronyms on first use. Use concise slides (no paragraphs); verbalise at most 1–2 unlisted citations (still in reference list). Time limit: 16:30—excess not marked.

• Referencing (5 marks): APA 7 for all sources and images (use “Note. From …” format on slides plus full reference list entry).

How the Academic Mentor Guided the Student

1. Clarify Alex’s profile and scope

   • Agreed on age/gender for Alex and a consistent clinical context (advanced cancer with bone metastasis).

   • Set learning outcomes for the session and the audience (graduate nurses).

2. Evidence strategy & referencing setup

   • Built a search plan (databases, keywords), prioritizing primary research and recent A&P texts; excluded general websites as main sources.

   • Prepared an APA 7 template (in-text, references, and image note format).

3. A&P section planning

   • Mapped key pathways of bony metastasis (osteolysis/osteoblastic activity, inflammatory mediators, periosteal stretch, nerve invasion, microfractures).

   • For each pathway, the mentor had the student pair a mechanism with a specific S&S (e.g., osteolysis → pathologic fractures; inflammatory sensitization → nociceptive pain; spinal involvement → neurological deficits).

   • Embedded pain mechanisms within these links and added a short justification for S&S prioritization (prevalence/impact on QoL/EOL).

4. Pain assessment plan

   • Framed a holistic assessment: physical (location/intensity/character), functional impact, psychosocial/spiritual, sleep, goals/values, caregiver input, and safety/risks.

   • Selected an appropriate tool (e.g., numerical/verbal rating for intensity; Brief Pain Inventory for interference) tailored to Alex’s capacity.

   • Wrote how-to steps: timing, environment, communication strategies, triangulating data (patient, family, records), and reassessment schedule.

5. Pharmacology recommendations

   • Linked choices to mechanisms (e.g., opioid for moderate–severe nociceptive pain; adjuvant such as a bisphosphonate/denosumab for bone pain; consider route like oral, subcutaneous, transdermal based on swallowing, nausea, or home setting).

   • Justified mode of delivery (e.g., transdermal for stable pain and adherence; subcutaneous for poor oral intake).

   • Supported with condition-specific evidence; excluded irrelevant options.

6. Non-pharmacological nursing interventions (two in depth)

   • Chose nursing-led options tightly tied to pain mechanisms, e.g.:

     • Positioning & immobilisation strategies (reduce periosteal stretch/micro-movement; safe transfer plans, braces, pressure care).

     • Thermal modalities & gentle activity pacing (heat/cold as appropriate; pacing to avoid flares; energy conservation; sleep hygiene).

   • For each: outlined rationale, step-by-step implementation, safety checks/contraindications, and evaluation measures.

7. Applying the RLT model

   • Identified affected Activities of Living (mobility, personal care, sleeping, work/leisure, expressing sexuality, dying).

   • Mapped lifespan (e.g., parental roles, employment/finances) and sociocultural factors (family structure, culture, beliefs, health literacy).

   • Converted these insights into person-centred care plans (preferences, shared decision-making, culturally safe communication) with at least one RLT citation.

8. Doctrine of Double Effect (DDE)

   • Defined DDE and situated it within Australian state/territory law (student stated one jurisdiction consistently).

   • Listed conditions for protection (intent to relieve symptoms, proportionality, documentation, consultation) and how nurses apply these in practice.

   • Clarified documentation and escalation steps.

9. Intro & conclusion drafting

   • Intro: presenter intro, purpose, concise session learning outcomes.

   • Conclusion: synthesis of content-level takeaways and explicit loop-back to outcomes.

10. Presentation polish & timing

    • Converted text to key phrases on slides; moved detail to speaker notes.

    • Checked acronyms, time-boxed the talk to ≤16:30, and verified APA 7 on slides and in the reference list (including image notes).

Outcome & Learning Objectives Covered

Outcome achieved:

• A structured, evidence-based presentation that links A&P mechanisms to S&S and pain, demonstrates a holistic and targeted pain assessment, provides justified pharmacological recommendations and two detailed nursing interventions, applies the RLT model to deliver person-centred care, and explains DDE within an Australian legal frame for safe decision-making. Slides are concise, time-compliant, and fully APA 7 referenced (including images).

Learning objectives covered:

• Apply pathophysiology to clinical S&S and pain.

• Conduct comprehensive pain assessment aligned with QoL/goals.

• Formulate mechanism-aligned pharmacologic recommendations and justify routes.

• Implement nursing-specific non-pharmacological strategies with clear how-to steps.

• Use the RLT model to integrate lifespan/sociocultural factors into person-centred care.

• Explain and apply DDE within the legal requirements of a specified jurisdiction.

• Communicate professionally to graduate-nurse peers with clear slides and APA 7 referencing within time limits.

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