Patient Pathways of Care in Adult Nursing 1: Level 7Types of Assessment:

  • A 15 – minute summative presentation of a case study on a client/patient you have cared for in practice. A transcript of the presentation must be uploaded onto the Moodle shell by the same date the reflective essay is submitted. (This presentation has a weighting of 50%, and the pass mark is 50% at level 7).
  • A 2,500 words summative reflective essay submitted via turnitin referring to the case study presented in class (the weighting is 50%, and the pass mark is 50% at level 7)
  • Practice Assessment Document – PAD (to be handed to the Faculty Office with a Header sheet on the date specified).

The 5 Learning Outcomes that are assessed include:

  1. Demonstrate a comprehensive and critical understanding of adult patient pathways of care within surgical and medical nursing both with the hospital and the community.
  2. Apply the principles of surgical and medical nursing to assess and develop care plans in partnership with the multi-agency team for various medical and surgical conditions within the hospital and the community setting.
  3. Demonstrate explicit knowledge and critical understanding of the implementation of national policies and local strategies and the impact they can have on the individual patient.
  4. Demonstrate the ability to apply national and local guidance and strategies to support practice within the students’ own sphere of professional practice.
  5. Critically evaluate the principles of surgical and medical adult nursing care, applying insight into discharge planning whilst minimising risk of harm and promoting health at all times.
  • A 15 – minute presentation (with 5 minutes for questions at the end)

The student must:

  • Select a patient they have cared for on a medical, surgical ward/unit or community placement. Anonymise patient details in accordance to NMC (2015).
  • Identify the patient journey, to include the admission route to hospital or the community and specific details about their presenting complaint and the pathway they were admitted under. E.g. Acute Cellulitis Pathway NICE (2015).
  • Discuss the overarching nursing assessment used to identify the patients’ problems on admission.
  • Critically analyse one element of nursing care (activity of daily living) delivered to the patient during their admission.
  • Ensure the discussion refers to relevant local & national policies and frameworks or strategies of care. Also discuss the other multi professionals involved in the patients’ care.

SUGGESTED LAYOUT 15 MINUTE ORAL/VISUAL PRESENTATION

Introduction: Be clear and concise, briefly state what you are going to cover in your presentation. Make sure you refer to all the learning outcomes and state that the patients name and personal details have been changed in line with NMC confidentiality guidelines.

Case Study: Introduce your chosen patient, explain how and why they presented to the hospital/community. (Remember your chosen patient has to have a medical or surgical condition and a reason for admission to hospital/community nursing team).

Specify the following information (you should be able to derive this information from the patients medical and nursing admission notes):

1)What was their admission pathway? Were they referred by their GP, via A+E, via outpatients or another route? Did they come by ambulance or public transport?

2) What was there presenting complaint and associated symptoms? Why do they need admission, what is the definitive diagnosis and medical plan of care?

3) Who was involved in their admission process? Who were they admitted under? E.g. surgeon. What type of ward were they admitted to, was this the correct clinical area? Were they transferred from one ward to another before arriving with you? Why was this?

Main Discussion: State which nursing assessment tool was used to assess the patient on admission, the most likely one you will see is Roper, Logan and Tierney. From the nursing assessment pick one element of care (activity of daily living) the patient required assistance with on admission and provide a rationale for this choice.

Critically analyse this one element of care, discussing how it was delivered in accordance to local policy/frameworks/procedures and guidelines. E.g. As the patient was admitted and kept nil by mouth then you could determine that eating and drinking was the most important element of care that needed to be immediately managed. Make sure that you focus on the nursing rather than medical management as this has to be relevant to your sphere of practice.

You should also refer to the other multi professionals involved in the patients care in regards to your chosen element. For example, if you chose eating and drinking you may wish to discuss the importance of determining a MUST score, and referring the patient to the dietician to ensure their nutritional needs were managed appropriately. Make sure you use contemporary references to support your arguments and discussion.

Conclusion: This needs to be a summary of your findings in relation to the nursing care given to your chosen patient for the one element of care you identified. There should be nothing new here and no new references.

  • REFLECTIVE ESSAY, REFERRING TO THE CASE STUDY PRESENTED IN CLASS

(2,500 WORDS)

The student is required to write a reflective essay 2,500 words in length. This will be based on the same patient discussed in the presentation. The student will critically reflect on the outcome of the care given to the patient, providing theoretical explanations and critical insights into the pathway followed, the MDT involvement, the implementation of national and local policy/guidance and finally applying insight into the discharge planning whilst minimising harm and promoting health at all times.

The student must:

Use a recognised model of reflection. For example: Kolb’s experiential learning cycle, Gibbs Model of reflection, Schön, Johns etc. …

Write an introduction, stating which reflective tool you have chosen and why? (don’t forget to reference it) and what you will be addressing in your essay (see above). Be clear and concise.

Briefly summarise your chosen patients presenting condition/complaint remembering to anonymise your patient.

EXAMPLE: Introduction

This reflective essay will focus on the care I provided for a patient during a placement on an acute surgical ward. I will be using Kolb’s (1984) four stage experiential learning cycle to help me carefully reflect on the experience. This cycle has been chosen because it focuses on observation as well as abstract conceptualisation which further demonstrates learning (Kolb, 1974). This essay will critically discuss the patient’s pathway of care, the implementation of local and national policies which influenced the care delivered as well as the contribution made by other members of the multi disciplinary team.  Finally, the patients discharge plan will be analysed with consideration given to health promotion opportunities that were presented.

In order to adhere to the Nursing and Midwifery Council (NMC) code of conduct (2015) regarding confidentiality, I have chosen the pseudonym of ‘Mr Hamill’ for my patient. Mr Hamill is a 64-year-old gentleman who presented to his GP with a 3-day history of constipation, nausea, vomiting and abdominal distention. He was referred to the on call surgeon at his local hospital and asked to attend the surgical assessment unit for further assessment. Mr Hamill was then admitted to an acute surgical ward under the ‘acute large bowel obstruction’ care pathway NICE (2014), for further examination and diagnostic investigations.

You can then continue to present your essay in accordance with the reflective tool/cycle you have chosen. Just ensure the discussion flows logically and you critically analyse the care given. You must remember to address the following learning outcomes:

  • Using a recognised model of reflection, critically analyse the care given to the patient within the context of medical/surgical/community nursing.
  • Provide critical explanations and insights into the care pathway followed, the MDT involvement, the implementation of national and local policy/guidance with reference to contemporary literature.
  • Apply insight into the discharge planning process whilst minimising harm and promoting health at all times.

Don’t forget to write a conclusion at the end of your reflective essay which will just be a short summary of how the reflective essay has helped you develop your understanding of the nursing care given in relation to the learning outcomes.

  • Practice Assessment Document (PAD) hand in date: TBC

Your PAD will be scrutinised by your personal tutor and is not marked specifically as part of this module. It is however, recorded on Banner whether the PAD was a pass or a technical fail. Please speak to your personal tutor for more details as required.

The student should remember:

  • These are guidance notes and should be read in conjunction with the assessment specification found in your module handbook and assessment lecture slides.
  • For this module you will need to ensure you clearly cover all learning outcomes. Remember to be critical in your writing at level 7. Seek support from the academic skills workshops if necessary.
  • Do not breach confidentiality of your Trust or the patient.
  • Make sure your arguments are underpinned by relevant and contemporary evidence. You will need to read widely around your patients underlying condition demonstrating best practice and an understanding of the care delivered.
  • A draft can be seen by the course leader. Please arrange this at least 4 weeks in advance of the hand in date. No drafts will be read two weeks prior to hand in date, in accordance with university guidelines.
  • Do not copy the example text in this guidance, all work will be assessed for plagiarism.