Course Title: Perform clinical assessment and contribute to planning nursing care

Part B: Course Detail

Teaching Period: Term2 2019

Course Code: NURS5376C

Course Title: Perform clinical assessment and contribute to planning nursing care

School: 174T School of VE Engineering, Health & Science

Campus: Bundoora Campus

Program: C5365 - Diploma of Nursing

Course Contact: Jaye Keating

Course Contact Phone: +61 3 9925 4845

Course Contact Email: jaye.keating@rmit.edu.au


Name and Contact Details of All Other Relevant Staff

Nominal Hours: 50

Regardless of the mode of delivery, represent a guide to the relative teaching time and student effort required to successfully achieve a particular competency/module. This may include not only scheduled classes or workplace visits but also the amount of effort required to undertake, evaluate and complete all assessment requirements, including any non-classroom activities.

Pre-requisites and Co-requisites

There are no pre-requisites for this unit of competency.

Course Description

This course of competency describes the skills and knowledge required, within the scope of practice, to perform preliminary and ongoing physical health assessments of all body systems, gathering data that contributes to a person’s individualised health care plan.

 

This course applies to enrolled nursing work carried out in consultation and collaboration with registered nurses, and under supervisory arrangements aligned to the Nursing and Midwifery Board of Australia regulatory authority legislative requirements.

 

This course includes a Work Integrated Learning experience in which your knowledge and skills will be applied and assessed in a real or simulated workplace context and where feedback from industry and/or community is integral to your experience.


This course includes clinical placement.


National Codes, Titles, Elements and Performance Criteria

National Element Code & Title:

HLTENN003 Perform clinical assessment and contribute to planning nursing care

Element:

1. Collect and interpret health data

Performance Criteria:

Collect and interpret health data.

1.1 Introduce self and explain processes before commencing nursing assessment activities.

1.2 Gather information from the person, or their family or carer if the person is unable to communicate, using culturally appropriate strategies.

1.3 Document the person’s gender, age and cultural, religious or spiritual data when undertaking the preliminary health assessment.

1.4 Measure the person’s vital signs using appropriate biomedical equipment according to the acuity of care and the person’s physical characteristics.

1.5 Perform clinical measurements and assessments when undertaking the clinical nursing assessment, identifying the person’s developmental state.

1.6 Record objectively the person’s lifestyle patterns, health history, current health practices, coping mechanisms, issues and needs.

1.7 Clarify the emotional and physical needs of the family or carer in supporting the person.

1.8 Use critical thinking to interpret objective and subjective data from the assessment, and determine if the data is or is not within normal range.

1.9 Communicate immediately all deterioration concerns about the person to registered nurse.

Element:

2.Undertake admission and discharge procedures

Performance Criteria:

Undertake admission and discharge procedures for a person.

2.1 Collect data from the person for admission and discharge planning as required by organisation policy and procedures.

2.2 Contribute to nursing assessment by documenting the person’s values and attitudes regarding health care, and any issues they may be experiencing that may impact on a timely discharge.

2.3 Identify community support services and resources to assist in planning for discharge.

2.4 Ensure the person has all discharge planning requirements including General Practitioner appointment and any medications and referrals.

Element:

3. Contribute to planning the nursing care of a person

Performance Criteria:

Contribute to planning the nursing care of a person.

3.1 Analyse a person’s health history and clinical assessment to identify risks and likely impacts on activities of daily living, and the health care that is required.

3.2 Outline a plan of care using a problem-solving approach and ensuring strategic care planning appropriate to the person’s needs.

3.3 Clarify and reflect the person’s interests and physical, emotional and psychosocial needs in care planning and documentation.

Element:

4. Contribute to ongoing development of individual nursing care plans.

Performance Criteria:

Contribute to ongoing development of individual nursing care plans

4.1 Analyse, using critical thinking, the rationale for specific decisions and the course of action taken in the person’s nursing care plan.

4.2 Confirm with the person, family or carer that planned nursing care provided reflects the person’s needs including their uniqueness, culture, religious beliefs and management of stress.

4.3 Ensure nursing care plan is based on principles of best practice and risk assessment.

4.4 Raise with the registered nurse or interdisciplinary health care team any conflicts between the nursing care plan and an already prescribed plan of care for the person.


Learning Outcomes


The critical learning for this course takes place in clinical placement within the health sector and within simulations in RMIT laboratories.

You will be instructed in skills through demonstration, modelling and role-play. Skills development is supported by lectures on theory and underpinning knowledge, classroom discussions, group work, research and reflective practice.

On completion of this course you should be able to:

  1. Collect and interpret health data.

    1.1 Introduce self and explain processes before commencing nursing assessment activities.

    1.2 Gather information from the person, or their family or carer if the person is unable to communicate, using culturally appropriate strategies.

    1.3 Document the person’s gender, age and cultural, religious or spiritual data when undertaking the preliminary health assessment.

    1.4 Measure the person’s vital signs using appropriate biomedical equipment according to the acuity of care and the person’s physical characteristics.

    1.5 Perform clinical measurements and assessments when undertaking the clinical nursing assessment, identifying the person’s developmental state.

    1.6 Record objectively the person’s lifestyle patterns, health history, current health practices, coping mechanisms, issues and needs.

    1.7 Clarify the emotional and physical needs of the family or carer in supporting the person.

    1.8 Use critical thinking to interpret objective and subjective data from the assessment, and determine if the data is or is not within normal range.

    1.9 Communicate immediately all deterioration concerns about the person to registered nurse.

  2. Undertake admission and discharge procedures for a person.

    2.1 Collect data from the person for admission and discharge planning as required by organisation policy and procedures.

    2.2 Contribute to nursing assessment by documenting the person’s values and attitudes regarding health care, and any issues they may be experiencing that may impact on a timely discharge.

    2.3 Identify community support services and resources to assist in planning for discharge.

    2.4 Ensure the person has all discharge planning requirements including General Practitioner appointment and any medications and referrals.

  3. Contribute to planning the nursing care of a person.

    3.1 Analyse a person’s health history and clinical assessment to identify risks and likely impacts on activities of daily living, and the health care that is required.

    3.2 Outline a plan of care using a problem-solving approach and ensuring strategic care planning appropriate to the person’s needs.

    3.3 Clarify and reflect the person’s interests and physical, emotional and psychosocial needs in care planning and documentation.

  4. Contribute to ongoing development of individual nursing care plans

    4.1 Analyse, using critical thinking, the rationale for specific decisions and the course of action taken in the person’s nursing care plan.

    4.2 Confirm with the person, family or carer that planned nursing care provided reflects the person’s needs including their uniqueness, culture, religious beliefs and management of stress.

    4.3 Ensure nursing care plan is based on principles of best practice and risk assessment.

    4.4 Raise with the registered nurse or interdisciplinary health care team any conflicts between the nursing care plan and an already prescribed plan of care for the person.


Details of Learning Activities

Learning Activities

All learning activities you will undertake within the course are designed to provide you with the skills, knowledge and attitudes required to perform to the standard expected in the health industry.

Learning activities include:

Face to face Tutorials – introduce you to the key concepts within the course
Practical workshops – provide an opportunity to practise your skills in a simulated work environment
Clinical placement – provides you with practical experience in a nursing workplace.


Teaching Schedule

Training Schedule Bundoora

Semester 2, 2019

Week

Content

Assessment

Lab Sessions

WK 1-7

No Classes - Course commences week 8

 

 

 

WK 8

Lesson 1:

Introduction

Assessments

Growth and Development

Genetics and environment

 

 

WK 9 

  

 

WK  10

 

 

 

 

WK 11

 Lesson 2:

Patient Centred Care

Lesson 3:

Clinical Measurements

 

 

WK 12

 Lesson 4:

Clinical Measurements

 

 

WK 13

 

 

Lab 1:

Vital signs, BGL, urinalysis

WK 14

 Lesson 5:

Primary and Secondary Survey

 

 

WK 15

 

AT1: Life Stages Assessment is due online via Canvas

Lab 2 Assessment:

AT2A- Urinalysis

 

WK 16

 

Resits if required

 

End of Semester 2, 2019

   


Learning Resources

Prescribed Texts


References


Other Resources

     

Other Resources   Textbooks are not compulsory and can be accessed via the library website   Recommended texts for this subject are:       Nursing Diagnosis Handbook An Evidence-based Guide to Planning Care, 11th edition, (2017) Ackley, B., Ladwig, G., & Flynn Makic, M.               (1st and 2nd year)                                                     Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 4th edition, (2014) Brown, D., Edwards, H., Seaton, L., & Buckley, T.                    (1st and 2nd year)                                                     Tabbner's Nursing Care: Theory and Practice, 7th edition, (2016), Koutoukidis, G., Stainton,K., & Hughson, J.     (1st and 2nd year)                                                                    Jarvis's Physical Examination and Health Assessment, 2nd edition, (2015), Forbes, H., & Watt, E.        (1st and 2nd year)         

                     


Overview of Assessment

This assessment will incorporate a variety of methods including written, oral, practical tasks and activities.

 

You will be asked to personally demonstrate to your teacher/assessor the practical skills gained during this course to the relevant industry standards. Assessment activities will occur throughout this course and feedback will be provided at regular intervals

 

Students must pass each of the following assessment tasks to demonstrate competent.

Assessment tasks

 

Assessment

Assessment 1

Life stages Research Assignment

Assessment 2

Practical Skills Assessment

Assessment 3

Health Assessment and Nursing Care Plan

Assessment 4

Clinical placement 

 

                       

To be deemed competent you must demonstrate an understanding of all aspects required of the competency. Assessment methods have been designed to measure your achievement of each competency in a flexible manner over multiple tasks.

 


Assessment Tasks

This assessment will incorporate a variety of methods including written, oral, practical tasks and activities.

 

You will be asked to personally demonstrate to your teacher/assessor the practical skills gained during this course to the relevant industry standards. Assessment activities will occur throughout this course and feedback will be provided at regular intervals

 

Students must pass each of the following assessment tasks to demonstrate competent.

Assessment tasks

 

Assessment

Assessment Task 1

Life stages Assessment

Assessment Task 2 A, B, C

Practical Skills Assessment:

AT2 A Urinalysis

AT2 B Body Mass Index

AT2 C Vital signs, BGL and Neurological Assessment

Assessment Task 3

Clinical Placement 

  

 

                       

To be deemed competent you must demonstrate an understanding of all aspects required of the competency. Assessment methods have been designed to measure your achievement of each competency in a flexible manner over multiple tasks.


Assessment Matrix

Performance Criteria

Related Assessment Task

 

 AT 1

AT 2

AT 3

1.1

 

 x

x

1.2

 

 

x

1.3

 

 x

 x

1.4

 

 x

 x

1.5

 

 x

 x

1.6

 x

 

 

1.7

 x

 

 x

1.8

 

 x

 x

1.9

 

 x

 x

2.1

 

 

x

2.2 

 

 

x

2.3 

 

 

x

2.4

 

 

 x

3.1

 x

x

 

3.2    

 x

 

x

3.3    

 x

 

x

 4.1

 

 

x

 4.2

x

 

x

 4.3

 

 

x

 4.4

 

 x

x

Other Information

Other Information

Please refer to the RMIT Student Page for extensive information about study support, assessments, extensions, appeals and a range of other matters:http://www1.rmit.edu.au/students

Re-submissions:

  You are permitted to have a maximum of 2 res-submissions for this course, however each individual assessment may only be resubmitted once.  Re-submissions are not automatic and will only be approved at the discretion of the program coordinator after consultation with the teacher.

  All re-submissions must be completed and submitted no more than 7 days after your work has been assessed.  Please note an opportunity to repeat clinical placement is not guaranteed and will be at the discretion of the Clinical Coordinator/Program Manager.

Attendance

It is a requirement that you attend all sessions in order to engage in the required learning activities, ensure the maximum opportunity to gain competency.

Special Consideration

Use the special consideration process if your circumstances are such that you cannot fulfil assessment requirements. For example, if you are unable to complete any piece of assessment by a due date, you will need to apply for an extension. 

Academic Integrity and Plagiarism

RMIT has a strict policy on plagiarism and academic integrity. Please refer to: http://www1.rmit.edu.au/students/academic-integrity for more information.

Working with Children Check and Police Check

This course requires a Working with Children Check and Police Check

 

Course Overview: Access Course Overview